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PTH-138 Assessing the Positive Predictive Value of Peptic Ulceration on Endoscopy for the Diagnosis of Helicobacter in a General Population
  1. F K Shaikh1,
  2. A A Palejwala1,
  3. M Madan1
  1. 1Gastroenterology/General Medicine, Burton Hospitals Foundation NHS Trust, Burton On Trent, UK

Abstract

Introduction Helicobacter Pylori (H. Pylori) is a gramme negative bacillus. It is strongly associated with peptic ulcer disease and gastric cancer. 50% of the population aged over 50 may be infected with H. Pylori. The prevalence in 2008 was 30–40% in the UK adult population with pockets of higher prevalence associated with deprivation. Different diagnostic tests including 13C urea breath test, stool antigen test, serum antibodies to H. pylori and rapid urease (CLO) test are commonly used in current medical practise. Histological detection of H. Pylori in gastric biopsy specimens still remains the gold standard investigation for diagnostic purposes. Our study was to assess whether peptic ulceration at endoscopy should be used to determine Helicobacter testing or whether all patient referred for Gastroscopy with ‘ non-reflux dyspepsia’ should be offered testing.

Methods It was a retrospective observational study analysing results of consecutive 172 patients who had CLO test performed (male 89, female 83) on a single user operator endoscopy list over a 4 months period (March to June 2010). CLO testing was carried out on the discretion of the endoscopist on any patient with unexplained ‘dyspepsia’ or endoscopic findings of peptic ulceration. Data on whether patients were on a proton pump inhibitor at the time of the endoscopy or concurrent use of non-steroidal anti-inflammatory drugs (NSAIDS) was not recorded.

Results Out of 172 cases, 34 cases were tested CLO positive (12/34 CLO positive patients had evidence of peptic ulcer disease on OGD).138 cases were tested CLO negative of which 62/138 had evidence of peptic ulcer disease. Prevalence figure in our study matched with national UK figures i.e 43.02% (95% CI: 35.51% to 50.78%).

Conclusion Approximately 1/3 of patients found to be CLO positive had signs of peptic ulceration (35%). In the same cohort of patients nearly ½ of patients found to be CLO negative also had signs of peptic ulceration (45%). In our study using evidence of peptic ulceration (gastritis, duodenitis, gastric and duodenal erosions/ulcers) as a guide as to whether a CLO test should be carried out is unhelpful. Caution has to be taken as we did not take into account data as to usage of PPI or NSAIDS. We suggest that presence of endoscopic findings should not be a sole determinant for Helicobacter testing.

Disclosure of Interest None Declared.

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