BACKGROUND: Helicobacter pylori is emerging as an important cause of peptic disease; however, few studies have been performed in primary care settings. This study examines the prevalence of H pylori in a population of primary care patients with refractory dyspepsia and evaluates the usefulness of currently available H pylori tests. METHODS: Consecutive patients with dyspepsia refractory to standard therapy were studied by endoscopy and tested for the presence of H pylori by means of four methods: office-based serology testing on endoscopically obtained specimens (CLO test), reference laboratory serology testing, rapid urease testing, and histologic diagnosis using special staining techniques. RESULTS: Among 41 patients with refractory dyspepsia, 19 (46%) were serology-positive, indicating past infection with H pylori. When compared with the reference laboratory standard, office-based serology testing had a sensitivity of 87% and a specificity of 100%. Using special stains on specimens obtained by biopsy, active H pylori infection was detected in 14 (34%) patients. Using special stains as a biopsy standard, the CLO test had a sensitivity of 93% and a specificity of 93%. CONCLUSIONS: Family physicians should consider adding H pylori eradication strategies to the treatment of patients with refractory dyspepsia. The rapid urease (CLO) test may be a useful adjunct for office-based family physicians who perform esophagogastroduodenoscopy. Serology alone is associated with a high false-positive rate due to past infection without active disease.
BACKGROUND:Helicobacter pylori is emerging as an important cause of peptic disease; however, few studies have been performed in primary care settings. This study examines the prevalence of H pylori in a population of primary care patients with refractory dyspepsia and evaluates the usefulness of currently available H pylori tests. METHODS: Consecutive patients with dyspepsia refractory to standard therapy were studied by endoscopy and tested for the presence of H pylori by means of four methods: office-based serology testing on endoscopically obtained specimens (CLO test), reference laboratory serology testing, rapid urease testing, and histologic diagnosis using special staining techniques. RESULTS: Among 41 patients with refractory dyspepsia, 19 (46%) were serology-positive, indicating past infection with H pylori. When compared with the reference laboratory standard, office-based serology testing had a sensitivity of 87% and a specificity of 100%. Using special stains on specimens obtained by biopsy, active H pylori infection was detected in 14 (34%) patients. Using special stains as a biopsy standard, the CLO test had a sensitivity of 93% and a specificity of 93%. CONCLUSIONS: Family physicians should consider adding H pylori eradication strategies to the treatment of patients with refractory dyspepsia. The rapid urease (CLO) test may be a useful adjunct for office-based family physicians who perform esophagogastroduodenoscopy. Serology alone is associated with a high false-positive rate due to past infection without active disease.