Appropriateness of urea breath test: a prospective observational study based on Maastricht 2000 guidelines.
BACKGROUND
The urea breath test is routinely used for diagnosing or confirming the eradication of Helicobacter pylori.


OBJECTIVE
To evaluate the appropriateness of urea breath test referrals.


METHODS
The age, sex, symptoms, endoscopic findings, use of non-steroidal anti-inflammatory drugs, family history of gastric cancer or H. pylori infection and concomitant diseases of patients referred for urea breath testing in a 1-year period were recorded. The appropriateness of urea breath test referrals was judged according to Maastricht guidelines.


RESULTS
One thousand, three hundred and twenty subjects (47 +/- 16 years) were referred in 2001: 578 (43.8%) for the diagnosis and 742 (56.2%) for confirmation of the eradication of H. pylori. The urea breath test was considered to be appropriate in 836 (63.3%) patients, inappropriate in 192 (14.5%) and appropriate but avoidable in 292 (22.1%). The appropriateness ratios of urea breath test referrals were 4.6 and 9.0 (P < 0.0001) for general practitioners and gastroenterologists, respectively. Of the patients (n=230) with un investigated dyspepsia, who underwent urea breath testing according to a 'test and treat' strategy, 98 (42.6%) presented at least one risk factor for organic disease.


CONCLUSIONS
In Italy, nearly 36% of urea breath test referrals are inappropriate or could be avoided if all dyspeptic patients with risk factors were referred for endoscopy or all dyspeptic patients undergoing endoscopy were tested for H. pylori infection with biopsy methods. Both general practitioners and, to a lesser extent, gastroenterologists require educational programmes to deal effectively with H. pylori.
Division of Gastroenterology, 'CSS' Hospital, IRCCS, San Giovanni Rotondo, Italy. f.perri@operapadrepio.it
F
F
Perri
R
R
Ricciardi
A
A
Merla
A
A
Piepoli
V
V
Gasperi
M
M
Quitadamo
A
A
Andriulli
D000328:Adult; D000368:Aged; D001944:Breath Tests; D002247:Carbon Isotopes; D016099:Endoscopy, Gastrointestinal; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D016481:Helicobacter Infections / Q000175:diagnosis*; D016480:Helicobacter pylori; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012017:Referral and Consultation / Q000592:standards; D019564:Unnecessary Procedures / Q000706:statistics & numerical data; D014508:Urea
D002247:Carbon Isotopes; D014508:Urea