Testing is useful only in patients at high risk of peptic ulcer disease, report the authors. Asking three simple questions during the consultation can identify these patients.
Between June 1996 and January 2000, general practitioners in Utrecht, Netherlands, recorded the age, sex, medical history, and smoking behaviour of 565 patients. All were suffering with dyspeptic symptoms of at least two weeks' duration.
The patients were subsequently tested for H pylori infection.
In all patients, smoking, pain on an empty stomach, and a history of peptic ulcer were independent predictors of peptic ulcer disease.
|Predictors of peptic ulcer disease:|
- Pain on an empty stomach
- History of peptic ulcer
|British Medical Journal|
Adding the H. pylori test did not provide any additional diagnostic information.
However, in a group of patients at high risk, identified by means of a simple scoring system, the predicted presence of peptic ulcer increased from 16% to 26% after a positive H. pylori test.
Despite some study limitations, the authors conclude that adding testing for H. pylori infection to history-taking might be useful only in patients at high risk of having peptic ulcer disease.
It would avoid invasive examinations for some patients and lead to more accurate treatment of peptic ulcer disease for most patients.