Prevalence of Helicobacter pylori in family practice patients with refractory dyspepsia: a comparison of tests available in the office.

BACKGROUND

Helicobacter pylori is emerging as an important cause of peptic disease; however, few studies have been performed in primary care settings. This study examines the prevalence of H pylori in a population of primary care patients with refractory dyspepsia and evaluates the usefulness of currently available H pylori tests.

METHODS

Consecutive patients with dyspepsia refractory to standard therapy were studied by endoscopy and tested for the presence of H pylori by means of four methods: office-based serology testing on endoscopically obtained specimens (CLO test), reference laboratory serology testing, rapid urease testing, and histologic diagnosis using special staining techniques.

RESULTS

Among 41 patients with refractory dyspepsia, 19 (46%) were serology-positive, indicating past infection with H pylori. When compared with the reference laboratory standard, office-based serology testing had a sensitivity of 87% and a specificity of 100%. Using special stains on specimens obtained by biopsy, active H pylori infection was detected in 14 (34%) patients. Using special stains as a biopsy standard, the CLO test had a sensitivity of 93% and a specificity of 93%.

CONCLUSIONS

Family physicians should consider adding H pylori eradication strategies to the treatment of patients with refractory dyspepsia. The rapid urease (CLO) test may be a useful adjunct for office-based family physicians who perform esophagogastroduodenoscopy. Serology alone is associated with a high false-positive rate due to past infection without active disease.