Scoring system has better discriminative value than Helicobacter pylori testing in patients with dyspepsia in a setting with high prevalence of infection

Objective To prospectively assess the accuracy of a scoring system to predi ct organic diseases in dyspeptic patients in an area of South Europe, and t o compare it with that of Helicobacter pylori testing in patients with dysp epsia in an environment with high prevalence of ii. pylori infection. Methods Symptoms and demographic data were recorded in 501 consecutive dysp eptic patients referred: to an outpatient gastroenterology clinic. A simple scoring system was constructed from the predictive factors obtained in a m ulti-variate logistic regression analysis. Overall predictive accuracy was assessed with the c statistic. The model was validated using bootstrap tech niques. The accuracy of clinical judgement and ii. pylori testing to predic t endoscopic diagnosis was also assessed. Results Organic dyspepsia (peptic ulcer, oesophagitis or malignancies) was diagnosed in 45% of the patients. The test for H. pylori was positive in 68 %, and 29% of infected patients had an ulcer. The organic dyspepsia predict ive model had an accuracy of 0.79, which decreased to 0.77 after validation adjustment. The predictive accuracies for clinical judgement and H. pylori testing were 0.69 and 0.61, respectively. The addition of ii pylori testin g to the scoring system resulted in a minor improvement of the predictive a ccuracy. Conclusion In an environment with a high rate of ii, pylori infection and a low prevalence of peptic ulcer among infected patients, a scoring system h as higher predictive accuracy for the diagnosis of organic disease than H, pylori testing. Moreover, in this setting, H.. pylori testing adds a minimu m value to the predictive capability of the scoring system, Eur J Gastroent erol Hepatol 12:1275-1282 (C) 2000 Lippincott Williams & Wilkins.