title: Can helicobacter pylori serology still be applied as a surrogate marker to identify peptic ulcer disease in dyspepsia?
abstract: 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.
authors.affiliation: Department of Medicine, The University of Sydney, Nepean Hospital, Australia.
authors.forename: H H
authors.initials: HH
authors.lastname: Xia
authors.forename: J S
authors.initials: JS
authors.lastname: Kalantar
authors.forename: H M
authors.initials: HM
authors.lastname: Mitchell
authors.forename: N J
authors.initials: NJ
authors.lastname: Talley
mesh_terms: 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
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers