Can helicobacter pylori serology still be applied as a surrogate marker to identify peptic ulcer disease in dyspepsia?
BACKGROUND
Helicobacter pylori infection and associated peptic ulcer disease (PUD) has become less common in some countries.


OBJECTIVE
To determine if H. pylori serology alone or combined with a history of ingestion of non-steroidal anti-inflammatory drugs (NSAIDs) and an age threshold can be used as an indirect ulcer test.


METHODS
Two hundred and fifty-two consecutive Australian patients (121 males, mean age 52 years) referred for endoscopy were enrolled. Blood was tested by a validated ELISA. At endoscopy, eight biopsies were taken for CLO-testing, culture and histology. NSAID use over the prior 3 months was recorded.


RESULTS
One hundred and six (42%) patients were seropositive for H. pylori, 48 (19%) patients had PUD and 30 (12%) used NSAIDs. Serology alone had a sensitivity of 52% and a specificity of 60% for identifying PUD; the sensitivity and specificity were 60% and 55%, respectively, when combined with a history of NSAID use. Serology, regardless of NSAID use, would have saved 23% in endoscopy workload but would have missed 17% of PUD cases if an age threshold of < 45 years was chosen for omitting endoscopy.


CONCLUSIONS
Serology was a poor ulcer test despite an excellent performance for detecting H. pylori. A strategy combining serology and an age threshold with a history of NSAID use to reduce endoscopy workloads may not always be appropriate.
Xia
H H
HH
Department of Medicine, The University of Sydney, Nepean Hospital, Australia.
Kalantar
J S
JS
Mitchell
H M
HM
Talley
N J
NJ
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D015415:Biomarkers / Q000032:analysis; D004724:Endoscopy; D004797:Enzyme-Linked Immunosorbent Assay / Q000592:standards; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis*; D016480:Helicobacter pylori / Q000276:immunology; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D010437:Peptic Ulcer / Q000175:diagnosis* / Q000382:microbiology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers