Testing for Helicobacter pylori in primary care: trouble in store?
OBJECTIVE
To assess the role of testing for Helicobacter pylori in the management of dyspeptic patients in primary care.


METHODS
Selective review of literature frequently quoted to support use of H pylori testing.


RESULTS
Testing for H pylori and referral of only positive cases for endoscopy aims to reduce the number of "unnecessary" endoscopies. Patients with negative results may receive short-term reassurance and subsequently place fewer demands on health services. However, studies to date have only assessed this practice in secondary care settings. Given the relatively high prevalence of both dyspepsia and H pylori infection, the transfer of this practice to primary care may lead to a paradoxical increase in endoscopy referrals. Identification of H pylori and prescribing of eradication treatment also aims to reduce endoscopy referrals. No primary care trials have yet assessed this approach. Given that fewer than one in four of dyspeptic patients have peptic ulceration, a high proportion may fail to respond to eradication treatment and subsequently require referral for endoscopy. The longer term clinical and psychosocial sequelae of treating or labelling patients with an infection associated with gastric cancer remain unknown.


CONCLUSIONS
Given uncertainty concerning the possible adverse effects of H pylori testing in primary care, we suggest a moratorium on its use in this setting until results from relevant clinical trials become available.
Centre For Cancer Epidemiology, University of Manchester, Christie Hospital NHS Trust, Withington.
R
R
Foy
J M
JM
Parry
L
L
Murray
C B
CB
Woodman
D000368:Aged; D001944:Breath Tests; D004415:Dyspepsia / Q000382:microbiology* / Q000628:therapy; D005194:Family Practice; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000628:therapy; D016480:Helicobacter pylori / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010437:Peptic Ulcer / Q000382:microbiology / Q000628:therapy; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000382:microbiology / Q000628:therapy