Helicobacter pylori stool test – antigen test at home

Helicobacter pylori is a bacterium that can colonise the stomach lining. The test detects components of the bacterium (antigens) in stool. A positive result is an indication that the bacterium is currently present in the stomach. Guidelines count the stool antigen test, together with the urea breath test, among the non-invasive detection methods (PubMed 29999489).

Infection with H. pylori is now generally classified as an infectious disease, regardless of whether there are symptoms (PubMed 35944925). What a positive result means for you and which next steps make sense therefore belongs in a doctor’s practice.

Not always. In a meta-analysis, laboratory antigen tests in adults detected on average around 92% of infections and were correctly negative in around 93% of non-infected people (PubMed 39928545). A small proportion of results is therefore wrong.

Acid blockers (proton pump inhibitors such as pantoprazole), antibiotics and bismuth preparations can influence the result. Whether and for how long you pause them before the test should be clarified with your doctor; do not stop them on your own. If symptoms persist despite a negative result, they should be assessed by a doctor.

The result is qualitative: Helicobacter pylori antigen detectable (positive) or not detectable (negative). The test says nothing about how much the stomach lining has changed, whether there is a stomach ulcer or whether the bacterium is resistant to certain antibiotics. That requires an endoscopy with tissue sample and further examinations.

Helicobacter pylori is a bacterium that can live in the stomach lining and cause chronic inflammation of the stomach lining (gastritis). It is considered an important cause of stomach and duodenal ulcers (PubMed 29999489). Many people with H. pylori have no symptoms.

According to a large meta-analysis, around 43% of people worldwide carry the bacterium; frequency has fallen in recent decades and is lower in high-income countries (PubMed 37086739).

H. pylori is transmitted from person to person, usually in childhood and often within the family. Reviews describe transmission within the household as an important route (PubMed 16798686). Whether family members should be tested is something to discuss with a doctor.

The stool antigen test and the urea breath test are non-invasive; tissue samples during an endoscopy with histology, culture or rapid test are invasive (PubMed 29999489). A blood test for antibodies shows whether there was contact with the bacterium at some point, but not reliably whether it is still present; studies using blood tests therefore report higher frequencies (PubMed 37086739).

If an infection is first found after the age of 50, the German guideline recommends, according to a review, an endoscopy with tissue sample (PubMed 29999489).

Gastritis is inflammation of the stomach lining. The international Kyoto consensus classifies gastritis caused by H. pylori as a separate form and describes how it is distinguished from other causes of stomach complaints (PubMed 26187502). However, gastritis can also have other causes, such as painkillers or alcohol. Whether gastritis is present can only be reliably determined by an endoscopy with a tissue sample; the stool test only shows whether the bacterium is present.

Whether and when a follow-up test after treatment makes sense is decided by the treating practice. There needs to be a gap between the end of treatment and the test, because antibiotics and acid blockers can distort the result. Agree on the timing with your doctor.

Research associates colonisation with H. pylori with the following complaints and consequences, with varying strength of evidence:

• Inflammation of the stomach lining (gastritis): H. pylori causes chronic gastritis; well documented (PubMed 26187502).
• Upper abdominal complaints such as fullness, pain or nausea (dyspepsia): a separate form of “H. pylori-associated dyspepsia” is described in the consensus (PubMed 26187502); the dyspepsia guideline provides for a non-invasive test in younger patients (PubMed 28631728).
• Stomach and duodenal ulcers: H. pylori is considered an important cause, well documented (PubMed 29999489).
• Iron deficiency and anaemia: more frequent in infected people, observed in a meta-analysis (PubMed 27411077).

Heartburn and belching have many other causes. These are associations from studies, not causes in an individual person. The test cannot explain symptoms and does not provide a diagnosis. Persistent symptoms should first be assessed by a doctor.

If you vomit blood or material resembling coffee grounds, have black tarry stools, difficulty swallowing, unintended weight loss, persistent vomiting, anaemia without an obvious cause or a palpable lump in the upper abdomen, the first step is a doctor’s practice or emergency department straight away, not a self-test. The same applies if new stomach complaints appear from around the age of 50: the dyspepsia guideline recommends an endoscopy from the age of 60, and earlier with increased risk, for example in the family (PubMed 28631728).

For severe, sudden upper abdominal pain, call the emergency number 112.

This page does not give treatment advice. Whether a result means anything at all and which steps make sense depends on your whole situation: symptoms, previous findings, medication and diet. Treating a confirmed infection is a medical decision; guidelines describe combinations of medicines for this and point to increasing antibiotic resistance (PubMed 29999489). Whether treatment worked is tested again afterwards.

What makes sense for you belongs in a conversation with the ORY expert team or with your doctor or naturopath, for example from the ORY expert network. The results consultation is included in the price.

Acid blockers (proton pump inhibitors), antibiotics and bismuth preparations can influence the result. Talk to your doctor before the test about whether and for how long you can pause them; do not stop prescribed medication on your own. Fill in the request form completely.

The stool must not come into contact with the toilet bowl or water; a paper stool catcher is included for this. Use the spoon in the lid to take a small amount from several places up to the mark, without overfilling. Label the tube with name, date and time, and do not send it on a Friday or before public holidays.

The analysis usually takes 7–21 days from the time the sample arrives at the laboratory. You will be notified as soon as your report is ready. The results consultation with the ORY expert team is included in the price.

The Helicobacter pylori stool test costs €65 including VAT, shipping, return shipping within Germany and the results consultation.

Statutory health insurance in Germany does not usually cover stool tests that you order yourself. With private insurance, reimbursement may be possible; the process is described under “Reimbursement by private insurance”.

The Helicobacter pylori stool test (€65) detects the bacterium in stool. For complaints in the bowel rather than the stomach, other tests may be considered, for example the lactose breath test (€65), the gliadin and transglutaminase stool test (€95) or the basic gut profile (€285). With warning signs, none of these is the right first step; see a doctor instead.

Which test makes sense for you can be clarified in the free initial consultation.