BMJ 2001;323:71-75 ( 14 July )

Papers

Testing for Helicobacter pylori in dyspeptic patients suspected of peptic ulcer disease in primary care: cross sectional study

Catherine F Weijnen, clinical research fellow, ^a Mattijs E Numans, senior lecturer, ^a Niek J de Wit, senior lecturer, ^a André J P M Smout, professor of gastroenterology, ^b Karel G M Moons, lecturer in clinical epidemiology, ^a Theo J M Verheij, professor of general practice, ^a Arno W Hoes, professor of clinical epidemiology. ^a

^a Julius Center for General Practice and Patient Oriented Research, University Medical Center Utrecht, Location Stratenum, Universiteitsweg 100, 3584 CG Utrecht, Netherlands, ^b Department of Gastroenterology, University Medical Center Utrecht

Correspondence to: C F Weijnen c.f.weijnen{at}med.uu.nl

Objectives: To develop an easily applicable diagnostic scoring method to determine the presence of peptic ulcers in dyspeptic patients in a primary care setting; to evaluate whether Helicobacter pylori testing adds value to history taking.
Design: Cross sectional study.
Setting: General practitioners' offices in the Utrecht area of the Netherlands.
Participants: 565 patients consulting a general practitioner about dyspeptic symptoms of at least two weeks' duration.
Main outcome measures: The presence or absence of peptic ulcer; independent predictors of the presence of peptic ulcer as obtained from history taking and the added value of H pylori testing were quantified by using multivariate logistic regression analyses.
Results: A history of peptic ulcer, pain on an empty stomach, and smoking were strong and independent diagnostic determinants of peptic ulcer disease, with odds ratios of 5.5 (95% confidence interval 2.6 to 11.8), 2.8 (1.0 to 4.0), and 2.0 (1.4 to 6.0) respectively. The area under the receiver operating characteristic curve (ROC area) of these determinants together was 0.71. Adding the H pylori test increased the ROC area only to 0.75. However, in a group of patients at high risk, identified by means of a simple scoring rule based on history taking, the predictive value for the presence of peptic ulcer increased from 16% to 26% after a positive H pylori test.
Conclusions: In the total group of dyspeptic patients in primary care, H pylori testing has no value in addition to history taking for diagnosing peptic ulcer disease. In a subgroup of patients at high risk of having peptic ulcer disease, however, it might be useful to test for and treat H pylori infections.

What is already known on this topic In primary care, predicting the presence of peptic ulcer disease in dyspeptic patients on the basis of history taking is difficult Infection with Helicobacter pylori is associated with peptic ulcer disease Many non-invasive H pylori tests are available, but the value they add to history taking is not known What this paper adds Three simple questions from history taking can distinguish between patients at high and low risk of peptic ulcer disease In uninvestigated patients with dyspepsia in primary care, H pylori testing adds nothing to optimal history taking in the diagnosis of peptic ulcer disease In patients at high risk of peptic ulcer disease it is useful to test for and treat H pylori infection

---

© BMJ 2001
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Testing for Helicobacter pylori in dyspeptic patients

Adam Jacobs, Alexander Williams, Kenneth E L McColl, Lilian S Murray, Ronald Sultana, Catherine F Weijnen, Mattijs E Numans, Niek J de Wit, Karel G M Moons, Theo J M Verheij, Arno W Hoes, and André J P M Smout
BMJ 2001 323: 1066. [Extract] [Full Text]

Helicobacter pylori testing is useful only in high risk patients
BMJ 2001 323: 0. [Full Text]

This article has been cited by other articles:

• Garcia-Altes, A., Santin, D., Barenys, M. (2007). Applying artificial neural networks to the diagnosis of organic dyspepsia. Stat Methods Med Res 16: 331-346 [Abstract]  
• Moons, K. G.M., Biesheuvel, C. J., Grobbee, D. E. (2004). Test Research versus Diagnostic Research. Clin. Chem. 50: 473-476 [Full text]  
• McColl, K E L, Murray, L S, Gillen, D, Walker, A, Wirz, A, Fletcher, J, Mowat, C, Henry, E, Kelman, A, Dickson, A (2002). Randomised trial of endoscopy with testing for Helicobacter pylori compared with non-invasive H pylori testing alone in the management of dyspepsia. BMJ 324: 999-999 [Abstract] [Full text]  
• Wodak, A., Reinarman, C., Cohen, P. D A, Drummond, C. (2002). For and against: Cannabis control: costs outweigh the benefits * For * Against. BMJ 324: 105-108 [Full text]  
• Jacobs, A., Williams, A., McColl, K. E L, Murray, L. S, Sultana, R., Weijnen, C. F, Numans, M. E, de Wit, N. J, Moons, K. G M, Verheij, T. J M, Hoes, A. W, Smout, A. J P M (2001). Testing for Helicobacter pylori in dyspeptic patients. BMJ 323: 1066-1066 [Full text]  
• (2001). Diagnosing Pathology in Dyspepsia. JWatch Gastroenterology 2001: 2-2 [Full text]  
• (2001). Testing for H. pylori Infection in Dyspeptic Patients. JWatch General 2001: 4-4 [Full text]  

Rapid Responses:

Read all Rapid Responses

Clinical significance of test seems dubious

Ronald Sultana
bmj.com, 16 Jul 2001 [Full text]

muddy waters

Alexander Williams
bmj.com, 19 Jul 2001 [Full text]

Statistical discrepancies

Adam Jacobs
bmj.com, 26 Jul 2001 [Full text]

H pylori test and treat - problems with selection by dyspeptic symptoms.

Kenneth E L McColl
bmj.com, 9 Aug 2001 [Full text]

Online poll

Find out more on doc2doc >>