Improved diagnostic accuracy is important in dyspepsia

EDITOR—Delaney et al's trial of Helicobacter pylori testing and endoscopy for dyspepsia in primary care surely misses the point of medical consultations for dyspepsia.1 Most doctors would view the purpose of a consultation as primarily to make a diagnosis before starting treatment. If the purpose is to initiate empirical prescribing—these authors seem to advocate this as they conclude that this “is … the best treatment”— the patients might as well go to a pharmacist and treat themselves.

This study is flawed. It uses a screening test for H pylori (Helisal) that has been reported to have sensitivities of only 67-88%, with a specificity of 78-91%. 2 3 The test is therefore not an accurate means of detecting H pylori, which presumably explains why so many ulcers were found in the control patients who were H pylori negative (four out of 48 endoscopies carried out).

Conclusions have been drawn on symptomatic follow up and quality of life data that were recorded for only just over half the patients studied. Costs were greater in patients in the study group, who all had endoscopy. We are not told whether these costs were significantly higher, but certainly some of this was due to the cost of H pylori testing, which, for some reason, was significantly higher (P<0.0001) in the study group.

As the authors acknowledge, endoscopic investigation showed significantly …