Symptom status and the desire for Helicobacter pylori confirmatory testingafter eradication therapy in patients with peptic ulcer disease

BACKGROUND: There is consensus that individuals with Helicobacter pylori-as sociated peptic ulcer disease should receive a test to confirm H. pylori cu re if symptoms recur after eradication therapy. It remains controversial wh ether individuals who are asymptomatic after therapy should undergo a confi rmatory test to establish cure. Patients' desire to know whether their infe ction has been cured and symptom status after treatment are two important d eterminants of whether confirmatory H. pylori testing should be undertaken routinely. METHODS: We identified 87 patients with H. pylori-associated peptic ulcer d isease scheduled to undergo urea breath testing 4 weeks after H. pylori era dication therapy. At the time of testing, willingness-to-pay methodology wa s used to estimate patients' desire for confirmatory testing in the absence of symptoms. At a follow-up visit after eradication therapy (mean follow-u p, 297 days; range, 143 to 494 days), patients were surveyed to assess gast rointestinal symptom status. RESULTS: Of the 87 patients, 78 (90%) responded that they would prefer to u ndergo confirmatory testing if asymptomatic, as opposed to delaying testing until symptoms recurred. Patients' median willingness to pay for confirmat ory testing in the absence of symptoms was greater than $50. On follow-up, 38% of patients in whom H. pylori was eradicated reported that their sympto ms were completely resolved. There was no significant difference in the per centage of patients who reported complete symptom resolution by H. pylori s tatus (H. pylori eradicated 38%, H. pylori infected 28%, P = 0.42, 95% conf idence interval, -14% to 34%). CONCLUSIONS: Patients' desire for confirmation of cure, coupled with a freq uent need for confirmatory testing as a result of recurrent symptoms after therapy, may justify routine confirmatory testing after H. pylori treatment . (C) 1999 by Excerpta Medica, Inc.