Can screening for IgG antibodies against Helicobacter pylori be used in clinical practice? Omit endoscopy in seropositive or seronegative patients?

The objective of this study was to test the feasibility of a screening strategy for IgG antibodies against Helicobacter pylori in patients presenting with upper abdominal complaints. Biopsy specimens were taken for histological and microbiological investigations from consecutive patients undergoing upper gastrointestinal endoscopy. In addition, a serum sample was taken for detection of IgG antibodies against Helicobacter pylori, using an ELISA technique. Serum samples from 1294 consecutive patients were available. IgG antibodies against Helicobacter pylori were present in 622 patients (48%), the remaining 671 (52%) were negative. If endoscopy had been omitted in seronegative patients below the age of 45 years, this would have resulted in 234 patients not endoscoped. However, it can be assumed that 62 of these patients would undergo endoscopy because of recurrent complaints due to underlying disease or abnormality. Therefore 182 of 1294 (14%) of endoscopies would have been avoided. Application of this strategy on the total group of seronegatives would save 353 of 1294 (27.3%) endoscopies. If endoscopy had been omitted in seropositive cases below the age of 45 years, and these patients were treated with anti-Helicobacter therapy, an initial 145 endoscopies would have been avoided. However, 26 of these patients would undergo endoscopy because of persistent complaints due to underlying disease. Therefore 119 (9%) endoscopies would have been avoided. Applying this strategy in the total group of seropositives would have saved 434 of 1294 endoscopies (34%). Applying the IgG screening strategy in all patients would result in a significant number of endoscopies being avoided in the seropositive group, 434 versus 353 (P < 0.001). In conclusion, omitting endoscopy in seropositive cases, regardless of age, can reduce the workload more than omitting endoscopy in seronegative cases: 34% fewer endoscopies versus 27%.