We read with great interest the article of Liou et al published in Gut ,1 and we would like to highlight some points. First, the authors stated that patients were considered positive only if two out of three tests performed (ie, rapid urease test, histology and culture) were positive. However, due to its high specificity (almost 100%),2 a positive culture alone can be considered a marker of Helicobacter pylori infection, as stated by guidelines for clinical trials on …