Rapid Urease Testing of Helicobacter pylori in Gastric Biopsies Compared With Culture

Abstract

When an endoscopist takes gastric biopsies from a patient with dyspepsia, one of the first questions is whether Helicobacter pylori is present, and two very different tools are often applied to the same piece of tissue: a rapid urease test that gives a colour change within minutes to hours, and culture, which takes days and demands careful transport and microaerobic incubation. This narrative review asks how the two compare and how far published comparisons can be trusted. It draws on published work on the biology of the organism and its urease, on the principles of each method, and on the design of diagnostic accuracy studies, and it reports no new data. The rapid test detects enzyme activity in a biopsy and is quick, cheap and usually highly specific; culture detects viable organisms, is more demanding and less sensitive in routine hands, but is the only route to antibiotic susceptibility testing. Both depend on bacterial load, so recent acid suppression or antibiotics, bleeding, atrophy and a low number of biopsies can lower the yield of either. Comparisons between the two are weakened by the lack of a perfect reference standard, by selected patient groups, and by incomplete reporting of the interval before reading. The review concludes that the rapid test is a sound first-line aid at the time of endoscopy, that a negative result needs careful interpretation, and that culture keeps a defined role where resistance matters.