Helicobacter pylori (HP) serology: an audit of action on positive serology results

Abstract

Introduction Hp causes peptic ulcer disease (PUD) and is potentially carcinogenic. Hp eradication is done in conditions like PUD, uncomplicated dyspepsia and persistent iron deficiency anaemia. 'Test and treat' implies testing specifi cally with intent to treat, if positive. CLO test is read in real time and acted on promptly. Hp serology is used in acute upper GI (UGI) bleed or endoscopy on PPI as CLO test is less sensitive. Results take 5-7 days by when in-patients have been discharged and positive Hp serology (Hp+ve) results overlooked. This audit was prompted by two such missed cases of Hp+ve PUD with rebleed in one. Aim To review action taken on Hp+ve results in our hospital, assess factors contributing to inaction, impact on patient care and remedial steps needed. Methods Retrospective study of all patients with Hp+ve requested by hospital clinicians in 12 months (1 April 2009 to 31 March 2010). Serology data from our microbiology department was matched with subsequent urea breath tests (UBT), our standard test to confi rm eradication. Patients with sequential serology and UBT were deemed to have received eradication. Case notes of the others were reviewed for test indication, point of fi rst contact, gastroscopy fi ndings (if