PROSPECTIVE SCREENING OF DYSPEPTIC PATIENTS BY HELICOBACTER-PYLORI SEROLOGY - A SAFE POLICY

Background and Study Aims: Endoscopic screening of all dyspeptic patie nts is not cost-effective, nor is it feasible in many health-care deli very systems, To select the most appropriate candidates, various preen doscopic screening strategies have been proposed, some of which includ e Helicobacter pylori serology and patient age, We assessed the value of these two criteria in preendoscopic screening of a large series of dyspeptic patients, and compared the results obtained in a referral ho spital (university center with an extensive H. pylori research program ) with those in nonreferral hospitals (participating centers that did not have such a program). Patients and Methods: Blood samples for dete rmination of anti-H. pylori IgG antibody were collected from patients with uninvestigated dyspepsia undergoing endoscopy at one referral hos pital and in 93 nonreferral hospitals throughout Italy, For IgG antibo dy assay, an inhouse enzyme-linked immunosorbent assay (ELISA) techniq ue was used in the referral hospital, while a commercial kit was used in the nonreferral hospitals. Results: A total of 1638 patients were e valuated at the referral hospital (845 men and 793 women, mean age 46. 1 years, range 18-89), and 3281 at the nonreferral hospitals (1718 men and 1563 women, mean age 38.8, range 18-96), respectively, If endosco py had not been performed in patients who were seronegative for H. pyl ori and younger than 45 years, 19% versus 17.5 % of the tests would ha ve been avoided in the referral and nonreferral hospitals, respectivel y, while six of 304 ulcers (2 %) and no cancers would have been missed versus 35 of 557 ulcers (6.3 %) and two of 557 cancers (0.3 %). Concl usions: A screening strategy based on age and H. pylori serology is a valid means of selecting dyspeptic patients for endoscopy; however, th e policy needs further refinement for use in nonreferral hospitals.