Abstract
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 of 85%, negative predictive value of 77% and accuracy of 82% 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 endoscopically 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.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Cheng E. H., Bermanski P., Silversmith M., Valenstein P., Kawanishi H. Prevalence of Campylobacter pylori in esophagitis, gastritis, and duodenal disease. Arch Intern Med. 1989 Jun;149(6):1373–1375. [PubMed] [Google Scholar]
- Dill S., Payne-James J. J., Misiewicz J. J., Grimble G. K., McSwiggan D., Pathak K., Wood A. J., Scrimgeour C. M., Rennie M. J. Evaluation of 13C-urea breath test in the detection of Helicobacter pylori and in monitoring the effect of tripotassium dicitratobismuthate in non-ulcer dyspepsia. Gut. 1990 Nov;31(11):1237–1241. doi: 10.1136/gut.31.11.1237. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gear M. W., Barnes R. J. Endoscopic studies of dyspepsia in a general practice. Br Med J. 1980 May 3;280(6223):1136–1137. doi: 10.1136/bmj.280.6223.1136. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Johansson K. E., Ask P., Boeryd B., Fransson S. G., Tibbling L. Oesophagitis, signs of reflux, and gastric acid secretion in patients with symptoms of gastro-oesophageal reflux disease. Scand J Gastroenterol. 1986 Sep;21(7):837–847. doi: 10.3109/00365528609011128. [DOI] [PubMed] [Google Scholar]
- Klauser A. G., Schindlbeck N. E., Müller-Lissner S. A. Symptoms in gastro-oesophageal reflux disease. Lancet. 1990 Jan 27;335(8683):205–208. doi: 10.1016/0140-6736(90)90287-f. [DOI] [PubMed] [Google Scholar]
- Williams B., Luckas M., Ellingham J. H., Dain A., Wicks A. C. Do young patients with dyspepsia need investigation? Lancet. 1988 Dec 10;2(8624):1349–1351. doi: 10.1016/s0140-6736(88)90879-3. [DOI] [PubMed] [Google Scholar]