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H Pylori tests not always useful for diagnosing ulcers


Testing for Helicobacter pylori in dyspeptic patients suspected of peptic ulcer disease in primary care: cross sectional study BMJ Volume 323, pp 71-75

Routine testing for H pylori infection in patients consulting their general practitioner with indigestion (dyspepsia) does not aid the diagnosis of peptic ulcers, concludes a study from the Netherlands in this week's BMJ.

Testing is useful only in patients at high risk of peptic ulcer disease, and these patients can be identified by asking three simple questions during the consultation, report the authors.

Between June 1996 and January 2000, general practitioners in Utrecht recorded the age, sex, medical history and smoking behaviour of 565 patients suffering with dyspeptic symptoms of at least two weeks' duration. All 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. 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 in some patients and lead to more accurate treatment of peptic ulcer disease in most patients.


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