title: 'Test and treat' policy in dyspepsia: time for a reappraisal.
abstract: The 'test and treat' policy is the recommended way to eradicate Helicobacter pylori in young patients with uninvestigated dyspepsia if the prevalence of H. pylori is high. India is considered to have a high prevalence of H. pylori. This observational study was conducted in order to discover the prevalence of H. pylori disease in uninvestigated dyspeptic patients, based on stool antigen test and immunoglobulin M (IgM) antibodies in the sera in order to ascertain the role of the 'test and treat' policy in this geographical area. Fifty patients (age <55 years) with uninvestigated dyspepsia presenting to surgery out-patient department of a tertiary teaching hospital in northern India were included in the study. Fifty healthy controls were also included. Dyspeptic patients with alarm symptoms were excluded from the study. Patients and controls were tested for IgM antibodies in their sera and H. pylori antigen in their stools. The positivity of the IgM antibody and H. pylori antigen in stools of the cases was 16% and 8%, respectively, while only 4% IgM positivity was found in the controls' samples. This study highlights the low prevalence of H. pylori in dyspeptic Indian patients. This indicates that initial proton pump therapy may be a better option than the 'test and treat' policy for young patients with uninvestigated dyspepsia.
authors.affiliation: Department of Microbiology, University College of Medical Sciences (UCMS) and Guru Teg Bahadur (GTB) Hospital, Delhi, India. dr_bineetakashyap@yahoo.co.in
authors.forename: Bineeta
authors.initials: B
authors.lastname: Kashyap
authors.forename: Iqbal R
authors.initials: IR
authors.lastname: Kaur
authors.forename: Pankaj Kumar
authors.initials: PK
authors.lastname: Garg
authors.forename: Dipmala
authors.initials: D
authors.lastname: Das
authors.forename: Sunny
authors.initials: S
authors.lastname: Goel
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000942:Antigens, Bacterial / Q000032:analysis*; D016022:Case-Control Studies; D004415:Dyspepsia / Q000188:drug therapy* / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D006291:Health Policy; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D016480:Helicobacter pylori / Q000187:drug effects / Q000276:immunology*; D006784:Hospitals, Teaching; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood*; D007194:India; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D015995:Prevalence; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial; D007075:Immunoglobulin M; D054328:Proton Pump Inhibitors