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. 2001 Jul 14;323(7304):71-5.
doi: 10.1136/bmj.323.7304.71.

Testing for Helicobacter pylori in dyspeptic patients suspected of peptic ulcer disease in primary care: cross sectional study

C F Weijnen  1 , M E Numans, N J de Wit, A J Smout, K G Moons, T J Verheij, A W Hoes
Affiliations

Testing for Helicobacter pylori in dyspeptic patients suspected of peptic ulcer disease in primary care: cross sectional study

C F Weijnen et al. BMJ. .

Abstract

Objectives: To develop an easily applicable diagnostic scoring method to determine the presence of peptic ulcers in dyspeptic patients in a primary care setting; to evaluate whether Helicobacter pylori testing adds value to history taking.

Design: Cross sectional study.

Setting: General practitioners' offices in the Utrecht area of the Netherlands.

Participants: 565 patients consulting a general practitioner about dyspeptic symptoms of at least two weeks' duration.

Main outcome measures: The presence or absence of peptic ulcer; independent predictors of the presence of peptic ulcer as obtained from history taking and the added value of H pylori testing were quantified by using multivariate logistic regression analyses.

Results: A history of peptic ulcer, pain on an empty stomach, and smoking were strong and independent diagnostic determinants of peptic ulcer disease, with odds ratios of 5.5 (95% confidence interval 2.6 to 11.8), 2.8 (1.0 to 4.0), and 2.0 (1.4 to 6.0) respectively. The area under the receiver operating characteristic curve (ROC area) of these determinants together was 0.71. Adding the H pylori test increased the ROC area only to 0.75. However, in a group of patients at high risk, identified by means of a simple scoring rule based on history taking, the predictive value for the presence of peptic ulcer increased from 16% to 26% after a positive H pylori test.

Conclusions: In the total group of dyspeptic patients in primary care, H pylori testing has no value in addition to history taking for diagnosing peptic ulcer disease. In a subgroup of patients at high risk of having peptic ulcer disease, however, it might be useful to test for and treat H pylori infections.

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Figures

Figure
Figure
Receiver operating characteristic curves from multivariate logistic regression analyses including the three diagnostic determinants for peptic ulcer disease (history of peptic ulcer, smoking, and pain on empty stomach) with or without additional non-invasive testing for Helicobacter pylori. The area under the curve without H pylori testing is 0.71 (SE 0.05); the area under the curve with H pylori testing is 0.75 (0.05)
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