Can Helicobacter pylori serology still be applied as a surrogate marker to identify peptic ulcer disease in dyspepsia?

• Published in: Alimentary pharmacology & therapeutics Vol. 14; no. 5; pp. 615 - 624
• Main Authors: XIA, H. H.-X, KALANTAR, J. S, MITCHELL, H. M, TALLEY, N. J
• Format: Journal Article
• Language: English
• Published: Oxford UK Blackwell Publishing Ltd 01-05-2000; Blackwell
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Biological and medical sciences; Biomarkers - analysis; Digestive system. Abdomen; Endoscopy; Enzyme-Linked Immunosorbent Assay - standards; Female; Functional investigation of the digestive system; Helicobacter Infections - complications; Helicobacter Infections - diagnosis; Helicobacter pylori - immunology; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical History Taking; Medical sciences; Middle Aged; Peptic Ulcer - diagnosis; Peptic Ulcer - microbiology; Predictive Value of Tests; Sensitivity and Specificity; Human; Spirillales; Dyspepsia; Spirillaceae; Biological marker; Serology; Enzyme immunoassay; Non steroidal antiinflammatory agent; Helicobacter pylori; Laboratory investigations; Digestive diseases; Bacteria; Diagnosis; ELISA assay; Anastomotic ulcer; Gastric disease
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1046/j.1365-2036.2000.00720.x

Background:
Helicobacter pylori infection and associated peptic ulcer disease (PUD) has become less common in some countries.
Aim:
To determine if H. pylori serology alone or combined with a history of ingestion of non‐steroidal anti‐inflammatory drugs (NSAIDs) and an age threshold can be used as an indirect ulcer test.
Methods:
Two hundred and fifty‐two consecutive Australian patients (121 males, mean age 52 years) referred for endoscopy were enrolled. Blood was tested by a validated ELISA. At endoscopy, eight biopsies were taken for CLO‐testing, culture and histology. NSAID use over the prior 3 months was recorded.
Results:
One hundred and six (42%) patients were seropositive for H. pylori, 48 (19%) patients had PUD and 30 (12%) used NSAIDs. Serology alone had a sensitivity of 52% and a specificity of 60% for identifying PUD; the sensitivity and specificity were 60% and 55%, respectively, when combined with a history of NSAID use. Serology, regardless of NSAID use, would have saved 23% in endoscopy workload but would have missed 17% of PUD cases if an age threshold of < 45 years was chosen for omitting endoscopy.
Conclusions:
Serology was a poor ulcer test despite an excellent performance for detecting H. pylori. A strategy combining serology and an age threshold with a history of NSAID use to reduce endoscopy workloads may not always be appropriate.