PREVALENCE OF HELICOBACTER-PYLORI IN FAMILY-PRACTICE PATIENTS WITH REFRACTORY DYSPEPSIA - A COMPARISON OF TESTS AVAILABLE IN THE OFFICE

Background. Helicobacter pylori is emerging as an important cause of p eptic disease; however, few studies have been performed in primary car e settings. This study examines the prevalence of H pylori in a popula tion of primary care patients with refractory dyspepsia and evaluates the usefulness of currently available H Pylori tests. Methods. Consecu tive patients with dyspepsia refractory to standard therapy were studi ed by endoscopy and tested for the presence of H pylori by means of fo ur methods: office-based serology testing on endoscopically obtained s pecimens (CLO test), reference laboratory serology testing, rapid urea se testing, and histologic diagnosis using special staining techniques . Results. Among 41 patients with refractory dyspepsia, 19 (46%) were serology-positive, indicating past infection with H pylori. When compa red with the reference laboratory standard, office-based serology test ing had a sensitivity of 87% and a specificity of 100%. Using special stains on specimens obtained by biopsy, active H pylori infection was detected in 14 (34%) patients. Using special stains as a biopsy standa rd, the CLO test had a sensitivity of 93% and a specificity of 93%. Co nclusions. Family physicians should consider adding H pylori eradicati on strategies to the treatment of patients with refractory dyspepsia. The rapid urease (CLO) test may be a useful adjunct for office-based f amily physicians who perform esophagogastroduodenoscopy. Serology alon e is associated with a high false-positive rate due to past infection without active disease.