Hindawi Publishing Corporation BioMed Research International Volume 2016, Article ID 4819423, 14 pages http://dx.doi.org/10.1155/2016/4819423 Review Article Diagnostic Methods of Helicobacter pylori Infection for Epidemiological Studies: Critical Importance of Indirect Test Validation Muhammad Miftahussurur1,2,3 and Yoshio Yamaoka1,4 1 Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu 879-5593, Japan 2Gastroentero-Hepatology Division, Department of Internal Medicine, Airlangga University, Faculty of Medicine, Surabaya 60131, Indonesia 3Institute of Tropical Disease, Airlangga University, Surabaya 60115, Indonesia 4Department of Gastroenterology and Hepatology, Baylor College of Medicine and Michael DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA Correspondence should be addressed to Yoshio Yamaoka;
[email protected] Received 2 October 2015; Accepted 16 December 2015 Academic Editor: Osamu Handa Copyright © 2016 M. Miftahussurur and Y. Yamaoka. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Among the methods developed to detect H. pylori infection, determining the gold standard remains debatable, especially for epidemiological studies. Due to the decreasing sensitivity of direct diagnostic tests (histopathology and/or immunohistochemistry [IHC], rapid urease test [RUT], and culture), several indirect tests, including antibody-based tests (serology and urine test), urea breath test (UBT), and stool antigen test (SAT) have been developed to diagnose H. pylori infection. Among the indirect tests, UBT and SAT became the best methods to determine active infection. While antibody-based tests, especially serology, are widely available and relatively sensitive, their specificity is low.