When compared with serology or stool antigen tests, the urea breath test has the highest diagnostic accuracy to identify H. pylori infection in patients without a history of gastrectomy or recent use of antibiotics or proton pump inhibitors. Use of any of these three methods in a hypothetical cohort with an H. pylori prevalence of 53.7% and fixed specificity of 90% resulted in 46 false-positive results out of 1,000 patients tested, and the urea breath test had the lowest falsenegative rate.1 (Strength of Recommendation: B, based on inconsistent or limited-quality patientoriented evidence.)