Possible role of Helicobacter pylori serology in reducing endoscopy workload

Abstract

Summary:We validated a commercial enzyme-linked immunosorbent assay (ELISA), Helico-G, in diagnosing H. pylori in 129 patients (mean age 50 years, range 15-86). We analysed the results of endoscopy against serology to see whether there was a possibility of adopting the strategy of not endoscoping dyspeptic subjects under the age of 45. H. pylori infection was considered present if either histology and/or culture were positive. The ELISA had a sensitivity of 88%, specificity of 72%, positive predictive value of85%, negative predictive value of77% and accuracy of82% in detecting H.pylori. In a subgroup of 52 subjects aged 45 or less (mean age 35 years, range 15-45), 17 out of 25 patients with positive endoscopic findings were H. pylori seropositive while 16 out of 27 patients had normal endoscopic findings. Eighteen out of the 52 patients (35%) were H. pylori seronegative and normal endoscopicaily except for five patients (10%) who had mild to moderate oesophagitis and two who had non-erosive gastritis (4%). All patients with duodenal ulcer disease (7) were seropositive giving predictive values of positive and negative serology for a diagnosis of duodenal ulcer disease as 28% and 100%, respectively.Therefore adopting a strategy of endoscoping subjects under the age of 45 only if they were H. pylori seropositive would have saved 35% of endoscopies in this age group but missed oesophagitis in 10%. Negative serology would tend to exclude duodenal ulcer disease while positive serology discriminates poorly for it. Serology may be a useful adjunct in screening to reduce endoscopy workload provided that patients with gastro-oesophageal reflux symptoms are excluded.

Serologic Diagnosis of Helicobacter pylori Infection in Outpatients Aged 45 Years or Less

“…Serology-based screening for ulcers has performed better than the usage of questionnaires [14]. However, ulcers may occur even in a small percentage of seronegative patients [10,12,14]. In the present study, 7% of all patients and 5-6% of patients in whom serological tests for Helicobacter pylori antibodies of the IgG class were negative (as measured by two EIA tests) had duodenal or gastric ulcers or erosive duodenitis.…”

“…A sensitive and inexpensive test could be used first, and positive results then confirmed by another test with high specificity, if practical in the clinical setting. If the "test-and-scope" policy [12] is followed, the presence of the infection can be confirmed at gastroscopy, and some false-positive results of screening tests would probably not be so harmful. If, however, the "test-and-treat" policy [21] is followed, the use of a screening test with low specificity could lead to the unnecessary prescription of antibiotics unless another test is used for confirmation.…”

“…The absence of Helicobacter pylori antibodies of the IgG class, as measured by EIA, is associated with a low probability of ulcer disease [11,12,13,14,15]. Serology-based screening for ulcers has performed better than the usage of questionnaires [14].…”

Seroepidemiology of Helicobacter pylori infection among preschool children in Taiwan.

“…It was proposed as pre-endoscopy screening to reduce endoscopy examination in young dyspeptic patients and in epidemiologic studies. 7,27,28 A significant difference in H. pylori seroprevalence was observed between aboriginal townships and metropolitan precincts in this study. A poor water supply system, sewage disposal, and other environmental hygiene in aboriginal townships might play contributing roles in the acquisition of H. pylori infection in central Taiwan.…”

High prevalence of Helicobacter pylori infection in Malaysian Parkinson's disease patients

“…Serology has a specificity of 79%-90% and sensitivity of 76%-84%. 27,28 UBT has sensitivity and specificity .95%. 30,31 Patients who have been positive for H. pylori may remain seropositive for up to 4 years after eradication.…”