The present standard of care includes testing for and treatment of Helicobacter pylori in patients with documented ulcer disease or recurrent dyspepsia. Although serologic assays have been widely used for the diagnosis of H pylori, the increasing availability of direct tests in the form of stool antigen and urea breath test provide diagnostic alternatives with higher positive predictive values. Use of “direct” tests leads to a reduction in unnecessary treatment, which is important because of the continuing concern regarding antimicrobial treatment and the emergence of antibiotic resistance. These tests each have the added feature of being able to be used as a test of cure when administered a month or more after completion of eradication therapy.