title: Treating Gastritis, Peptic Ulcer Disease, and Dyspepsia in the Emergency Department: The Feasibility and Patient-Reported Outcomes of Testing and Treating for Helicobacter pylori Infection.
abstract: OBJECTIVE
  Helicobacter pylori infection is a known cause of gastritis, dyspepsia, and peptic ulcer disease. Testing for infection is indicated in high-prevalence outpatient settings. The objective of this prospective cohort study is to examine the feasibility of a test-and-treat strategy in the emergency department (ED) setting.
  
  
  METHODS
  During a 13-month period at an academic ED, symptomatic patients underwent a point-of-care urea breath test (BreathID; Exalenz Bioscience Inc., Modiin, Israel) during the ED visit. Research assistants abstracted treatment information from the electronic medical record. Patients who tested positive were prescribed triple-therapy medication. All enrollees were telephoned 2 weeks after the index ED visit to ascertain symptom resolution and treatment compliance. H pylori-positive subjects were asked to return to the ED for retest. Risk differences in patient and clinical characteristics were compared by H pylori infection status, and a paired t test was used to estimate differences in pain resolution at the ED visit and follow-up.
  
  
  RESULTS
  Of the 465 symptomatic patients, 271 were eligible and 212 enrolled and were tested for H pylori. Forty-nine patients (23%) (95% confidence interval [CI] 18% to 30%) had a positive result, 33 of 49 (67%) (95% CI 53% to 79%) self-reported receiving the medication as prescribed at follow-up, 23 of 49 (47%) (95% CI 34% to 61%) were retested, and 20 of 49 (41%) (95% CI 28% to 55%) had a negative result. There was a significant reduction in pain severity, regardless of H pylori infection status.
  
  
  CONCLUSIONS
  A test-and-treat strategy is feasible in the ED setting and could benefit symptomatic patients.
authors: Department of Emergency Medicine, George Washington University, Washington, DC. Electronic address: ameltzer@mfa.gwu.edu.
authors: Andrew C
authors: AC
authors: Meltzer
authors: Department of Emergency Medicine, George Washington University, Washington, DC.
authors: Lauren E L
authors: LE
authors: Winter
authors: Department of Emergency Medicine, George Washington University, Washington, DC.
authors: Paige
authors: P
authors: Kulie
authors: Department of Emergency Medicine, George Washington University, Washington, DC.
authors: Cameron
authors: C
authors: Benedict
authors: Department of Emergency Medicine, George Washington University, Washington, DC.
authors: Kelvin
authors: K
authors: Lim
authors: Department of Emergency Medicine, George Washington University, Washington, DC.
authors: Otabek
authors: O
authors: Ishmukhamedov
authors: Department of Emergency Medicine, George Washington University, Washington, DC.
authors: Melissa L
authors: ML
authors: McCarthy
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004415:Dyspepsia / Q000175:diagnosis* / Q000188:drug therapy; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D005756:Gastritis / Q000175:diagnosis* / Q000188:drug therapy; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000188:drug therapy; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000175:diagnosis* / Q000188:drug therapy; D019095:Point-of-Care Systems; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents