Intended for healthcare professionals


Test and treat for dyspepsia—but which test?

BMJ 2005; 330 doi: (Published 13 January 2005) Cite this as: BMJ 2005;330:105
  1. Cliodna McNulty (, consultant medical microbiologist,
  2. Louise Teare, consultant medical microbiologist,
  3. Robert Owen, head,
  4. David Tompkins, laboratory director,
  5. Peter Hawtin, clinical scientist,
  6. Kenneth McColl, professor of gastroenterology
  1. Health Protection Agency Primary Care Unit, Microbiology Department Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN
  2. Mid-Essex, Department of Microbiology, Chelmsford CM2 OYX
  3. Campylobacter and Helicobacter Reference Unit, Health Protection Agency, Specialist and Reference Microbiology Division, London NW9 5HT
  4. Health Protection Agency, Yorkshire and the Humber, Leeds Laboratory, Leeds LS15 7TR
  5. Health Protection Agency, Southampton Laboratory, Southampton General Hospital, Southampton SO16 6YD
  6. University of Glasgow, Western Infirmary, Glasgow G11 6NT

    Urea breath test and stool antigen test are better than serological tests

    Managing dyspepsia costs the NHS over £500m annually.1 European dyspepsia guidelines and those from the National Institute for Clinical Excellence (NICE) say that patients with persistent or recurrent uncomplicated dyspepsia should have a non-invasive Helicobacter pylori test and, if the test is positive, receive triple therapy.24 With a policy requiring non-invasive testing and treatment we need to use an accurate test so that the patients receive the correct treatment. The urea breath test and serology were the first non-invasive tests available; the urea breath test is the more accurate. This test detects products of the enzyme urease produced by live H pylori in the stomach and is 95% sensitive and specific.5 The breath test has not been used much in primary care in the United Kingdom, probably because it is time consuming as it requires two breath samples, taken 20 minutes apart.

    Serology is the …

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