From targets to standards: but not just yet

stool, 65 for urea breath test of 2000) of patients will receive unnecessary antibiotics.3 5 In contrast, using a serology based test 255 of the 2000 patients tested are likely to receive an incorrect diagnosis of active H pylori infection and receive inappropriate treatment.2 3 5 Serology leads to at least four times as many false positive results as the urea breath test or second generation monoclonal stool antigen test, with associated unnecessary treatment and increasing risks of antibiotic resistance in other bacterial flora.If the dyspepsia "test and treat" guidance is implemented widely across Europe the number of patients receiving treatment to eradicate H pylori could easily double.We need to have an easy, accurate diagnostic test and the stool antigen test is just that.The European Helicobacter Study Group 4 and NICE dyspepsia guidance 3 now endorse the use of urea breath tests or stool antigen tests over serology.Any small additional cost to the healthcare provider will be far offset by improved diagnostic accuracy and reduced use of antibiotics.Furthermore, as these tests replace serology and market forces come into play, the price of the breath and stool tests is likely to come down.Clinicians are therefore best advised to inform patients that the minor inconvenience of providing a stool or breath sample is far outweighed by the increased accuracy of the tests.Clinicians should request healthcare providers to fund office based tests or local laboratories to include these tests in their repertoire.