USEFULNESS OF ANTI-HELICOBACTER PYLORI AND ANTI-CAGA ANTIBODIES IN THE SELECTION OF PATIENTS FOR GASTROSCOPY

Objectives: Screening of dyspeptic patients with serological tests for Helicobacter pylori before open-access gastroscopy has been suggested to be worthwhile. CagA-positive H. pylori strains may be associated w ith major pathology more often than CagA-negative strains. The usefuln ess of anti-H. pylori and anti-CagA antibodies in screening for gastro scopy was evaluated in unselected dyspeptic patients. Methods: Four hu ndred consecutive, unselected dyspeptic patients (mean age, 56.8 yr) i n primary care were investigated with gastroscopy, ultrasonography of the upper abdomen, laboratory tests (including serological tests for H . pylori and CagA), and other examinations if needed. The patients wer e followed for 1 yr. Results: Results of serological tests were positi ve for H. pylori in 56.2% of patients, of whom 64.4% also had results positive for CagA. Use of H. pylori and CagA serology-based screening combined with a history of nonsteroidal anti-inflammatory drug use wou ld have detected only 80 and 70% of the major pathologies (peptic ulce r, moderate or severe esophagitis, celiac disease, or malignancy), res pectively, in these patients. Gastroscopy would have been avoided in 3 0 and 41%, respectively, if only patients who had positive results on serological tests or who were nonsteroidal anti-inflammatory drug user s would have been referred. In patients younger than 45 yr of age (n = 87), 60-74% of gastroscopies would have been avoided, but 50-60% of m ajor pathologies would have been missed, by using the screening strate gy studied. One of the nine malignancies (all in patients >45 yr of ag e) was H. pylori-negative, and two were CagA-negative. Conclusions: An ti-CagA antibodies do not offer advantages compared with anti-H. pylor i antibodies in screening patients for gastroscopy. A remarkable share of major pathologies are missed by both of these screening methods. T herefore, the results of these screening tests are not recommended as selective criteria for gastroscopy.