Introduction. Helicobacter pylori infection is a global public health problem due to its high incidence and associated gastrointestinal diseases. Currently, diagnostic methods are classified as invasive and non-invasive, with varying levels of validity and no consensus on their clinical application. Objective. To compare the diagnostic accuracy of invasive and non-invasive methods for detecting H. pylori infections, based on scientific evidence regarding sensitivity and specificity. Methodology. A systematic review of the evidence was conducted according to the PRISMA 2020 guidelines, focusing on Scopus, PubMed/MEDLINE, and Web of Science, using MeSH controlled terms and descriptors such as: Helicobacter pylori, diagnosis, diagnostic methods, detection, sensitivity, and specificity, combined using Boolean operators. Primary studies on diagnostic accuracy were selected; methodological quality and risk of bias were assessed using QUADAS-2. Results: The comparative analysis showed that invasive methods (histology, biochemical testing for urease activity, and real-time polymerase chain reaction on biopsy specimens) achieved the highest sensitivity and specificity values. Among the non-invasive methods (carbon-13-labeled urea breath test and fecal polymerase chain reaction), validity performance was equivalent to that of invasive methods, establishing them as diagnostic alternatives for H. pylori. Conclusions. The available evidence suggests that invasive methods offer the highest diagnostic accuracy; however, emerging techniques and modalities, along with the implementation of artificial intelligence systems in the diagnosis of H. pylori, are moving toward combined strategies that integrate high-accuracy noninvasive methods. General Area of Study: Clinical laboratory. Specific area of study: Health and Wellness. Type of study: Systematic review.