Validade de instrumento epidemiológico para rastrear H. pylori entre pacientes dispépticos

Abstract

OBJECTIVE:To validate an epidemiological score for identifying dyspeptic patients at high risk of being H. pylori positive. METHODS:Cross-sectional study including 434 users of primary health care units in the city of Pelotas, Southern Brazil, aged 18-45 years, and with symptoms of non-investigated dyspepsia, between 2006 and 2007. Dyspepsia was diagnosed according to Roma-II. The gold standard for H. pylori infection was the 13 C-urea-breath-test. The association between presence of H. pylori and independent variables was assessed through Logistic Regression. The score was built based on adjusted odds ratios. Sensitivity, specifi city, and predictive values of different cutoffs were calculated. RESULTS:Prevalence of H. pylori dyspeptic subjects was 73.5% (95% CI: 69.3; 77.7). Prevalence was directly associated with age and number of siblings during childhood, and inversely associated with schooling; these variables were used in the construction of the score. The score ranged from 3 to 9 points. Scores 7, 8, and 9 had sensitivity of 36.6%, 22.3%, and 11.1%, and positive predictive values of 87.8%, 90.9%, and 92.1%, respectively. Without the score, 3 in every 4 dyspeptic patients would have received H. pylori erradication therapy. This proportion would have been lower with the score (one in three, six, and 11, for the cutoff points betwewen 7 and 9, respectively), albeit at the expense of a high rate of false-negatives. CONCLUSIONS:The score was not valid for selectively identifying dyspeptic individuals candidate to eradication therapy for H. pylori. Contrary to the recommendation in developed countries, the test-and-treat strategy seems inappropriate for use in developing settings due to the high prevalence of H. pylori infection.

Correlation between the symptoms of upper gastrointestinal disease and endoscopy findings: Implications for clinical practice

“…22 , 30 However, a Brazilian study did not observe a relationship between digestive symptoms and the presence of bacteria, which agrees with the current study's data. 31 …”