Can screening for IgG antibodies against Helicobacter pylori be used in clinical practice? Omit endoscopy in seropositive or seronegative patients?

Can screening for IgG antibodies against Helicobacter pylori be used in clinical practice? Omit endoscopy in seropositive or seronegative patients?

The objective of this study was to test the feasibility of a screening strategy for IgG antibodies against Helicobacter pylori in patients presenting with upper abdominal complaints. Biopsy specimens were taken for histological and microbiological investigations from consecutive patients undergoing...

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Bibliographic Details
Published in:Digestive diseases and sciences Vol. 43; no. 10; pp. 2296 - 2300
Main Authors: WERDMULLER, B. F. M, V.DER PUTTEN, A. B. M. M, VEENENDAAL, R. A, LAMERS, C. B. H. W, LOFFELD, R. J. L. F
Format: Conference Proceeding Journal Article
Language:English
Published: Heidelberg Springer 01-10-1998
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Antibodies, Bacterial - blood
Biological and medical sciences
Digestive system. Abdomen
Endoscopy
Endoscopy, Gastrointestinal
Enzyme-Linked Immunosorbent Assay
Female
Helicobacter Infections - diagnosis
Helicobacter pylori - immunology
Humans
Immunoglobulin G - blood
Investigative techniques, diagnostic techniques (general aspects)
Male
Medical sciences
Middle Aged
Netherlands
Europe
Human
Evaluation
Seropositivity
Spirillales
Antibody
Spirillaceae
Instrumentation therapy
IgG
Laparoscopy
Medical screening
Gastrointestinal
Infection
Immunology
Helicobacter pylori
Biopsy
Bacteriosis
Digestive diseases
Bacteria
Surgical approach
Feasibility
Endoscopy
ELISA assay
Gastric disease
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Summary:The objective of this study was to test the feasibility of a screening strategy for IgG antibodies against Helicobacter pylori in patients presenting with upper abdominal complaints. Biopsy specimens were taken for histological and microbiological investigations from consecutive patients undergoing upper gastrointestinal endoscopy. In addition, a serum sample was taken for detection of IgG antibodies against Helicobacter pylori, using an ELISA technique. Serum samples from 1294 consecutive patients were available. IgG antibodies against Helicobacter pylori were present in 622 patients (48%), the remaining 671 (52%) were negative. If endoscopy had been omitted in seronegative patients below the age of 45 years, this would have resulted in 234 patients not endoscoped. However, it can be assumed that 62 of these patients would undergo endoscopy because of recurrent complaints due to underlying disease or abnormality. Therefore 182 of 1294 (14%) of endoscopies would have been avoided. Application of this strategy on the total group of seronegatives would save 353 of 1294 (27.3%) endoscopies. If endoscopy had been omitted in seropositive cases below the age of 45 years, and these patients were treated with anti-Helicobacter therapy, an initial 145 endoscopies would have been avoided. However, 26 of these patients would undergo endoscopy because of persistent complaints due to underlying disease. Therefore 119 (9%) endoscopies would have been avoided. Applying this strategy in the total group of seropositives would have saved 434 of 1294 endoscopies (34%). Applying the IgG screening strategy in all patients would result in a significant number of endoscopies being avoided in the seropositive group, 434 versus 353 (P < 0.001). In conclusion, omitting endoscopy in seropositive cases, regardless of age, can reduce the workload more than omitting endoscopy in seronegative cases: 34% fewer endoscopies versus 27%.
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ISSN:0163-2116
1573-2568
DOI:10.1023/A:1026683026028