CAN SCREENING FOR IGG ANTIBODIES AGAINST HELICOBACTER-PYLORI BE USED IN CLINICAL-PRACTICE - OMIT ENDOSCOPY IN SEROPOSITIVE OR SERONEGATIVE PATIENTS

The objective of this study was to test the feasibility of a screening strategy for IgG antibodies against Helicobacter pylori in patients p resenting with upper abdominal complaints. Biopsy specimens were taken for histological and microbiological investigations from consecutive patients undergoing upper gastrointestinal endoscopy. In addition, a s erum sample was taken for detection of IgG antibodies against Helicoba cter pylori, using an ELISA technique. Serum samples from 1294 consecu tive patients were available. IgG antibodies against Helicobacter pylo ri were present in 622 patients (48%), the remaining 671 (52%) were ne gative. If endoscopy had been omitted in seronegative patients below t he age of 45 years, this would have resulted in 234 patients not endos coped. However, it can be assumed that 62 of these patients would unde rgo endoscopy because of recurrent complaints due to underlying diseas e or abnormality. Therefore 182 of 1294 (14%) of endoscopies would hav e been avoided. Application of this strategy on the total group of ser onegatives would save 353 of 1294 (27.3%) endoscopies. If endoscopy ha d been omitted in seropositive cases below the age of 45 years, and th ese patients were treated with anti-helicobacter therapy, an initial 1 45 endoscopies would have been avoided. However, 26 of these patients would undergo endoscopy because of persistent complaints due to underl ying disease. Therefore 119 (9%) endoscopies would have been avoided. Applying this strategy in the total group of seropositives would have saved 434 of 1294 endoscopies (34%). Applying the IgG screening strate gy in all patients would result in a significant number of endoscopies being avoided in the seropositive group, 434 versus 353 (P < 0.001). In conclusion, omitting endoscopy in seropositive cases, regardless of age, can reduce the workload more than omitting endoscopy in seronega tive cases: 34% fewer endoscopies versus 27%.