TITLE

DIAGNOSIS OF HELICOBACTER PYLORI IN A DISTRICT GENERAL HOSPITAL (DGH): ACCURACY, COST AND PATIENT PREFERENCE FOR SIX WIDELY AVAILABLE TESTS

AUTHOR(S)
Gordon, C.; Thatcher, P.; Youd, P.; Stratford, A.; Gould, S.R.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA72
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Introduction: The detection of H pylori forms part of the care pathway for dyspepsia. However, there are many tests to choose from, and no clear guidance as to which one to use. Aims: To determine the positive and negative predictive value (PPV and NPV), sensitivity (Sens) and specificity (Spec) and cost of the urea breath test (UBT), in-house prepared rapid urease test (RUT), histology (histo), culture (cult), serology (sero), and faecal antigen (HpSA) in H pylori diagnosis, and to examine the patient's preference. Methods: 109 patients were recruited from an open access endoscopy (OGD) service. Samples were taken at OGD for RUT, histology, culture, and serology. UBT and faecal antigen test were carried out within seven days. The gold standard for a positive test for H pylori was taken as a positive UBT with one other positive test. Cost minimisation analysis was performed for all tests. Patient preference was determined via a questionnaire to 100 patients in the general medicine OP department. Results: The prevalence of H pylori in our population was 16%. In response to the questionnaire, 20% opted for OGD, 49% for a blood test, 15% for the UBT, and 16% for the stool test. Discussion: Our area has a Iow H pylori prevalence, which can decrease the accuracy of all the tests. However, from our data all the tests show similar accuracy apart from the serology, which performs poorly. The patients overall preferred a non-invasive test. The faecal antigen shows a clear cost advantage, the RUT, histology, and culture all require an OGD and this increases the cost markedly. The cost of the UBT is increased by the necessity for a dedicated nurse to do the tests. Conclusion: On the basis of accuracy, cost, and patient preference, the faecal antigen test is the test of choice for the diagnosis of H pylori.
ACCESSION #
9747769

 

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