Helicobacter: can a microbiome test help?

A microbiome test can detect Helicobacter pylori by identifying its DNA in stool samples. However, clinical utility is limited: the gold standard for diagnosing active infection remains the ¹³C-urea breath test and stool antigen test. Microbiome analyses often only show the presence of H. pylori DNA, not whether there is a treatment-requiring gastritis or increased gastric cancer risk. Moreover, standardized cut-offs and reference values for bacterial load are lacking. A positive finding should therefore always be confirmed by a validated test. Evidence is mixed: studies confirm detectability in principle, but clinical decision-making remains uncertain. A microbiome test can serve as supplementary information but does not replace medical evaluation. Caution against overinterpretation – especially in asymptomatic individuals, where H. pylori may also occur as a harmless commensal.