Helicobacter pylori and Gastroduodenal Diseases: Advances in Diagnostic Strategies and Clinical Implications

Abstract

Background: Helicobacter pylori causes a substantial global burden of gastroduodenal disease, including peptic ulcer, gastric MALT lymphoma, and adenocarcinoma. Accurate, context-specific diagnosis is essential to guide eradication therapy, reduce complications, and enable cancer prevention, yet test performance varies with bacterial distribution, medication exposure, bleeding, and prior surgery. Objective: To synthesize contemporary diagnostic strategies for H. pylori, integrate evidence from guidelines and primary studies, and appraise emerging tools—artificial intelligence (AI)–assisted endoscopy and proteomics—for their clinical utility and implementation. Methods: We conducted a narrative review of English-language literature (2000–2025) across PubMed, Scopus, and Web of Science, supplemented by guideline statements (Maastricht, ACG/CAG, Japanese) and reference snowballing. Evidence was organized by invasive versus non-invasive modalities, clinical scenarios (dyspepsia, bleeding, pediatrics, post-gastrectomy, test-of-cure), and translational technologies (AI, proteomics). Results: Urea breath test and monoclonal stool antigen assays consistently demonstrated ≥90% accuracy for initial diagnosis and post-treatment confirmation, contingent on appropriate medication washout. Biopsy-based histology, rapid urease testing, culture, and molecular assays offered complementary information—particularly for histopathology and resistance profiling—but were impacted by sampling and pre-analytical factors. AI systems improved endoscopic recognition and biopsy targeting, while proteomic studies identified candidate biomarkers (e.g., HSPs, annexins, ENO1, GKN1) with diagnostic and prognostic potential; however, external validation and workflow standardization remain limiting. Conclusion: Optimal H. pylori diagnosis requires individualized test selection and, where appropriate, combined strategies. AI and proteomics are poised to augment established pathways, enabling precision, resistance-aware care and earlier cancer prevention once validated and operationalized. Keywords: Helicobacter pylori; urea breath test; stool antigen; endoscopy; histopathology; rapid urease test; culture; PCR; antibiotic resistance; artificial intelligence; proteomics; biomarkers; gastric cancer; dyspepsia; precision medicine