title: Usefulness of serology in preendoscopic screening. The Italian Helicobacter pylori Study Group.
abstract: BACKGROUND
  Over the last 20 years, upper gastrointestinal endoscopy has become the investigation of choice for patients with symptoms referrable to the upper gastrointestinal tract. As the increasing number of patients referred for endoscopy has led to enlarged waiting lists and medical expenses, it has been recommended that preendoscopic screening strategies might identify patients at low risk of having major pathology. These patients could avoid prompt endoscopy and might safely undergo different management. Since the recognition of the major role played by Helicobacter pylori in gastroduodenal pathology, H. pylori serological and demographical features have been proposed as part of preendoscopic screening strategies in dyspeptic patients referred to endoscopy, in an attempt to reduce endoscopic workload and medical expenses.
  
  
  METHODS
  We evaluate data presented in the literature and aim to give interpretations possibly helpful in the clinical practice.
  
  
  RESULTS
  The analysis of the endoscopic findings showed that applying a preendoscopic strategy based on age and H. pylori status in local hospitals without a specific interest in H. pylori research would have meant missing a proportion of relevant pathology: 35 of 557 (6.3%) peptic ulcers (24 duodenal and 11 gastric ulcers) and two gastric cancers (0.3%).
  
  
  CONCLUSIONS
  Although we do understand the need to increase the cost-effectiveness of endoscopy and realize that considering age and H. pylori status could help to get to this target, we conclude that similar preendoscopic screening strategies must be refined further before being adopted on a large scale.
authors.affiliation: First Medical Clinic, University of Bologna, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Vaira
authors.forename: M
authors.initials: M
authors.lastname: Menegatti
authors.forename: F
authors.initials: F
authors.lastname: Landi
authors.forename: C
authors.initials: C
authors.lastname: Ricci
authors.forename: A
authors.initials: A
authors.lastname: Ali
authors.forename: M
authors.initials: M
authors.lastname: Miglioli
mesh_terms: D016099:Endoscopy, Gastrointestinal; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000517:prevention & control*; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008403:Mass Screening; D012699:Serology