What proportion of dyspeptic patients having H-pylori breath test subsequently undergo endoscopy?

Background: Helicobacter pylori (HP) testing in young patients with uncompl icated dyspepsia has been recommended. A test and treat strategy for dyspep tics positive for HP is recommended by the European H. pylori Study Group a nd the American Gastroenterology Association. Objectives: To assess the rates of re-referral for upper GI endoscopy (OGD) and outpatient (OPD) attendance in uncomplicated dyspeptic patients follow ing assessment of HP status. Methods: 190 patients under 50 years of age with uncomplicated dyspepsia (w ithout alarm symptoms) referred from general practitioners (GPs) to the gas troenterology department underwent HP urea breath test (UBT). GPs were info rmed of the results of UBT and recommended eradication therapy if positive, and if negative advised symptomatic treatment with an acid suppressant with /without a prokinetic. The patients were analysed for subsequent attendance at OGD or OPD in the following two years. Results: HP was present in 93 of 190 patients. Twenty of 190 (10.5%) patien ts subsequently were re-referred and underwent OGD for continuing dyspeptic symptoms; a further 6 were seen in OPD but not endoscoped as they have bee n judged to have uncomplicated gastro-oesophageal reflux disease. At time o f OGD all patients were negative on Campylobacter-like organism (CLO) test for HP. Findings at OGD were normal (9), hiatus hernia (6), gastritis (4) a nd duodenitis (1). No case of peptic ulcer disease or gastric cancer has be en identified. Conclusions: In this group of dyspeptic patients, adopting a test and treat policy after initial analysis of HP resulted in 10.5% being re-referred fo r subsequent OGD; findings in those endoscoped were normal or minimal. A te st and treat strategy for H. pylori in uncomplicated dyspeptics therefore s aves endoscopies and outpatient consultations without missing significant u nderlying pathology.