<b><i>Background and Aim:</i></b> According to several guidelines, both invasive and non-invasive tests can be used to detect Helicobacter pylori (<i>H. pylori</i>). Invasive methods include <i>H. pylori</i> culture, histological staining, rapid urease tests (RUTs) and PCR. Non-invasive methods include urease breath test, stool antigen and serum IgG testing. The aim of our study was to compare all commercially available RUTs and histology in Germany. <b><i>Material and Methods:</i></b> One hundred fifty patients were enrolled in our study, irrespective of proton pump inhibitors (PPIs) or antibiotic use. If the results of RUTs and histology were diverging, real-time PCR to detect <i>H. pylori</i> DNA was undertaken. <b><i>Results:</i></b> We detected no differences in the sensitivity or specificity between the different RUTs. In PPI and/or antibiotic-treated patients, RUTs seemed to be more sensitive for the detection of <i>H. pylori</i> infection compared to histology. In addition to the cheaper price of RUTs, they are also quicker to process. We show that histological staining in patients with signs of gastritis is expensive and not necessary, if there are no additional histological questions besides <i>H. pylori</i> status. <b><i>Conclusions:</i></b> In conclusion, we consider RUTs to be cheap and fast alternatives to histology in patients with endoscopic signs of gastritis, independently of whether PPIs or antibiotic are used. Histological evaluation is expensive, time consuming and may be unnecessary in some cases.