Predicting ulcer disease in dyspeptic patients by H. Pylori testing rather than endoscopy

ABSTRACT

To validate accuracy of the Rapid Blood Test [RBT] in predicting peptic ulcer disease in dyspeptic patients. Rationale Most patients with dyspepsia have no pathology at endoscopy, thus are exposed to unjustified risk, cost, and inconvenience associated with this invasive assessment. Setting: Medical World Polyclinic and Dar Al-Shefa Hospital, Riyadh, KSA. Patients One hundred patients with ulcer- like dyspepsia. All patients underwent a RBT followed by endoscopy with antral biopsies for histology and urease slide test [CLO test]. Sixty-five% of the patients were "gold standard" H. pylori positive [positive CLO test, positive histology], 30% were "gold standard" negative [negative CLO test, negative histology], and 5% had conflicting CLO test and histology results. Patients with peptic ulcer disease included 31% of all dyspeptic patients, 42% of H pylori-infected patients, and 7% of non-infected individuals. RBT could determine H. pylori status with a sensitivity of 91% and specificity of 77%. Positive and negative predictive values of the test were 89% and 79% respectively. In predicting peptic ulcer disease, RBT was sensitive in 93% of patients and specific in 41%. Positive and negative predictive values of the test were 41% and 93% respectively. Conclusions: RBT is reliable in determining H. pylori status. However, we cannot predict the development of peptic ulcer disease merely on the presence or absence of H. pylori