Can Helicobacter pylori serology still be applied as a surrogate marker toidentify peptic ulcer disease in dyspepsia?

Background: Helicobacter pylori infection and associated peptic ulcer disea se (PUD) has become less common in some countries. Aim: To determine if H. pylori serology alone or combined with a history of ingestion of non-steroidal anti-inflammatory drugs (NSAIDs) and an age thr eshold can be used as an indirect ulcer test. Methods: Two hundred and fifty-two consecutive Australian patients (121 mal es, mean age 52 years) referred for endoscopy were enrolled. Blood was test ed by a validated ELISA. At endoscopy, eight biopsies were taken for CLO-te sting, culture and histology. NSAID use over the prior 3 months was recorde d. Results: One hundred and six (42%) patients were seropositive for H. pylori , 48 (19%) patients had PUD and 30 (12%) used NSAIDs. Serology alone had a sensitivity of 52% and a specificity of 60% for identifying PUD; the sensit ivity and specificity were 60% and 55%, respectively, when combined with a history of NSAID use. Serology, regardless of NSAID use, would have saved 2 3% in endoscopy workload but would have missed 17% of PUD cases if an age t hreshold of < 45 years was chosen for omitting endoscopy. Conclusions: Serology was a poor ulcer test despite an excellent performanc e for detecting H. pylori. A strategy combining serology and an age thresho ld with a history of NSAID use to reduce endoscopy workloads may not always be appropriate.