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Letters

Routine retesting is necessary

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7042.1362 (Published 25 May 1996) Cite this as: BMJ 1996;312:1362
  1. T G Reilly,
  2. R P Walt
  1. Clinical research fellow University of Birmingham, Queen Elizabeth Hospital, Birmingham B15 2TH
  2. Consultant gastroenterologist Birmingham Heartlands Hospital, Birmingham B9 5SS

    EDITOR,—The decision whether to retest for Helicobacter pylori after a course of eradication treatment in peptic ulcer disease depends on the likely outcome. If one expects that the organism will nearly always be killed by a course of such treatment and that there will be few other dyspeptic symptoms not due to ulcer, then arguing against routine retesting makes sense. Perminder S Phull and colleagues adopt just such an argument on the basis of finding a 2.5% prevalence of symptoms of reflux and no other dyspepsia in their patients from whom H pylori had been eradicated.1 This low figure for continuing symptoms is, however, at odds with figures reported elsewhere and suggests that the study population may have been preselected on the basis of having “pure” duodenal ulcer disease. We found that in 140 patients with peptic ulcer whose infection was successfully treated 39% reported heartburn, 25% reported symptoms of the irritable bowel syndrome, and 22% had a further consultation with the general practitioner during a median follow up of 249 days.2 Powell et al found that 12-18% of patients with peptic ulcer used H2 receptor antagonists in each three month period after successful eradication of H pylori.3

    In practice, regimens to eradicate H pylori achieve a success rate of 85% at most. The 15-20% of patients in whom the treatment fails are highly likely to experience recurrent symptoms and to present again, and our figures suggest that up to a third of patients in whom eradication is successful will eventually present again. In other words, around a third of all patients given eradication treatment for peptic ulcer disease can be expected to visit their doctor again with dyspepsia. Routine retesting after eradication treatment enables the clinician to provide reassurance for those in whom it has been successful if they have recurrent dyspepsia and to prescribe repeat eradication treatment in advance of clinical relapse in those in whom it has failed; in addition, routine retesting may of itself reduce reconsultation rates. Routine retesting remains our practice.

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