Symptom status and the desire for Helicobacter pylori confirmatory testing after eradication therapy in patients with peptic ulcer disease.
BACKGROUND
There is consensus that individuals with Helicobacter pylori-associated peptic ulcer disease should receive a test to confirm H. pylori cure if symptoms recur after eradication therapy. It remains controversial whether individuals who are asymptomatic after therapy should undergo a confirmatory test to establish cure. Patients' desire to know whether their infection has been cured and symptom status after treatment are two important determinants of whether confirmatory H. pylori testing should be undertaken routinely.


METHODS
We identified 87 patients with H. pylori-associated peptic ulcer disease scheduled to undergo urea breath testing 4 weeks after H. pylori eradication therapy. At the time of testing, willingness-to-pay methodology was used to estimate patients' desire for confirmatory testing in the absence of symptoms. At a follow-up visit after eradication therapy (mean follow-up, 297 days; range, 143 to 494 days), patients were surveyed to assess gastrointestinal symptom status.


RESULTS
Of the 87 patients, 78 (90%) responded that they would prefer to undergo confirmatory testing if asymptomatic, as opposed to delaying testing until symptoms recurred. Patients' median willingness to pay for confirmatory testing in the absence of symptoms was greater than $50. On follow-up, 38% of patients in whom H. pylori was eradicated reported that their symptoms were completely resolved. There was no significant difference in the percentage of patients who reported complete symptom resolution by H. pylori status (H. pylori eradicated 38%, H. pylori infected 28%, P = 0.42, 95% confidence interval, -14% to 34%).


CONCLUSIONS
Patients' desire for confirmation of cure, coupled with a frequent need for confirmatory testing as a result of recurrent symptoms after therapy, may justify routine confirmatory testing after H. pylori treatment.
Fendrick
A M
AM
Consortium for Health Outcomes, Innovation, and Cost-Effectiveness Studies, University of Michigan School of Medicine, USA.
Chey
W D
WD
Margaret
N
N
Palaniappan
J
J
Fennerty
M B
MB
D001944:Breath Tests / Q000379:methods; D004522:Educational Status; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000191:economics* / Q000382:microbiology; D016480:Helicobacter pylori; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000188:drug therapy / Q000191:economics* / Q000382:microbiology*; D014481:United States; D014508:Urea / Q000378:metabolism
D014508:Urea