Helicobacter pylori "test-and-scope" strategy for dyspeptic patients. Is it useful and safe?

Aim. To evaluate outcome of test-and-scope strategy using C-13-urea breath test, Helicobacter pylori IgG serology, and CagA serology. Patients and methods. A series of 100 dyspeptic patients were studied. Biop sies were obtained for histology and rapid urease test (gold standard). Ser um samples were obtained for Helicobacter pylori IgG and CagA serology, and C-13-urea breath test was carried out. Results. If endoscopy had not been performed in Helicobacter pylori patient s based on C-13-urea breath test, <45 years, without alarm symptoms, and wi thout non-steroidal anti-inflammatory drug use, 15% of endoscopies would ha ve been saved, and one gastric ulcer and two oesophagitis would have been m issed. Based on Helicobacter pylori IgG serology 21% of endoscopies would h ave been saved. Finally, if endoscopy had been performed only in CagA+ pati ents, 31% of endoscopies would have been saved, missing one gastric ulcer a nd two cases of oesophagitis. Conclusions. In our geographical area, the test-and-scope strategy based on C-13-urea breath test or Helicobacter pylori IgG serology would have saved only 15-20% of endoscopies. Although some relevant pathology would have be en missed, it is not of a malignant type. C-13-urea breath test is the pref erred non-invasive method to be used in this strategy, while Helicobacter p ylori IgG serology is of limited value due to its low accuracy. With the us e of CagA serology a larger number of unnecessary endoscopic examinations c an be avoided.