Value of the "Test & Treat" Strategy for Uninvestigated Dyspepsia at Low Prevalence Rates of Helicobacter pylori in the Population.
OBJECTIVE
In populations with a low prevalence rate of Helicobacter pylori (H. pylori) infection from Western countries, guidelines for the management of uninvestigated dyspepsia generally recommend that the "test and treat" strategy should be avoided in favor of empiric proton-pump inhibitor therapy in younger patients (on average < 50 years of age) without alarm symptoms and signs. The prevalence of H. pylori infection has fallen from about 30% to about 10% in Sweden and other countries. We aimed to explore whether the rationale for test and treat is relevant in contemporary clinical practice.


METHODS
In settings with an infection rate in the adult population of 30% and 10%, we modeled the positive and negative predictive values for indirect (nonendoscopy) tests on current H. pylori infection with a presumed sensitivity and specificity of 95%. We then calculated the difference in false-negative and false-positive test outcome, and eradication prescription rates in the two scenarios.


RESULTS
While the positive predictive value for the test decreased from 0.89 to 0.68 when the prevalence of H. pylori fell from 30% to 10%, there were only 1% more false-negative tests and 1% less false-positive tests. The eradication prescription rate would decrease by 18% with a 10% prevalence rate.


CONCLUSIONS
The recommendation to stop applying "test and treat" at lower prevalence rates of H. pylori should be reconsidered. The test and treat strategy is the preferred approach for most patients who present with dyspepsia.
Division of Family Medicine, Karolinska Institutet, Stockholm, Sweden.
Lars
L
Agréus
Faculty of Health and Medicine, University of Newcastle, NSW, Australia.
Nicholas J
NJ
Talley
Department of Psychology, Macquarie University, Sydney, NSW, Australia.
Michael
M
Jones
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004415:Dyspepsia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D005188:False Negative Reactions; D005189:False Positive Reactions; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D012680:Sensitivity and Specificity
D000900:Anti-Bacterial Agents
Helicobacter pylori; Test and treat; dyspepsia/diagnosis; primary care