PROSPECTIVE SCREENING OF DYSPEPTIC PATIENTS BY HELICOBACTER-PYLORI SEROLOGY

Helicobacter pylori infection is associated with 95% of duodenal ulcer s and more than 80% of gastric ulcers. Several reports have indicated that screening for H pylori may avoid subsequent endoscopic examinatio n. We screened 183 dyspeptic patients, aged under 45, by taking a hist ory of sinister symptoms and regular use of non-steroidal anti-inflamm atory drugs (NSAIDs), together with serological testing for H pylori. Endoscopy was performed on 113 patients, of whom 90 (49%) were seropos itive, 14 (8%) had sinister symptoms, and 9 (5%) had used NSAIDs regul arly. In 34 (19%) patients we detected peptic ulceration. The remainin g 70 (38%) patients who were H pylori seronegative, had no sinister sy mptoms, and had not taken NSAIDs (screen-negative), did not undergo en doscopy but were returned to their primary care physician for treatmen t of symptoms, At subsequent reassessment (of the non-endoscoped group ), symptom severity (p=0.002), interference with life events (p=0.01), and medication (p=0.0002) were all significantly lower in the 6 month s after screening than in the 6 month period before screening. Only th ree screen-negative patients were re-referred after screening endoscop ic findings were normal. Thus, endoscopies were avoided. When the non- endoscoped screen-negative patients were compared with a cohort of end oscoped screen-negative patients, the groups did not differ in terms o f symptom severity (odds ratio 1.12, 95% CI 0.53-2.35, p=0.77) or inte rference with life events (0.82, 0.38-1.76, p=0.61). However, medicati on use was significantly less (0.37, 0.17-0.80, p=0.01) in those who d id not have an endoscopy. Our study indicates that colonisation screen ing based on H pylori serology, a history of sinister symptoms, or a h istory of NSAID use was worthwhile in dyspeptic patients. We avoided 3 7% of endoscopies and reduced drug usage without disadvantaging those not endoscoped.