Is Repeat Testing Needed for Helicobacter pylori?
Is Repeat Testing Needed for Helicobacter pylori?
Helicobacter pylori is a major cause of gastritis and gastric and duodenal ulcer disease, and it increases the risk of gastric cancer. Diagnosis and treatment of H pylori infection has become an essential part of the evaluation of patients with dyspepsia and other upper abdominal symptoms. Until recently, diagnosis was made primarily by endoscopic biopsy, and treatment was initiated primarily by gastroenterologists. Several noninvasive office-based diagnostic tests are now readily available to primary care physicians. Measurement of serum antibodies against H pylori is probably the most commonly used noninvasive test, although it does not distinguish active from previous infection. Measurement of the H pylori antigen in the stool and breath tests using urea (labeled with C and C carbon) are more accurate determinants of active H pylori infection. Because of the availability of noninvasive tests, there is an increased role for the primary care physician in diagnosing and managing this disorder.
The need to retest patients for eradication of the bacteria after treatment has not been established. The success of bacterial eradication depends primarily on patient compliance and on antibiotic resistance, and it varies in different populations. Recurrence rates after confirmed eradication are less than 1% per year. In our community we had noted that some of our patients with previously treated H pylori infection who later required repeat endoscopy still had active infection, as determined by endoscopic biopsy. With the recent availability of the low-cost on-site C-labeled urea breath test, we began testing patients with previously treated H pylori infection to confirm eradication. A retrospective chart review was done to determine whether the incidence of failed treatment warranted recommending repeat testing of all patients cared for by our primary care physicians.
Helicobacter pylori is a major cause of gastritis and gastric and duodenal ulcer disease, and it increases the risk of gastric cancer. Diagnosis and treatment of H pylori infection has become an essential part of the evaluation of patients with dyspepsia and other upper abdominal symptoms. Until recently, diagnosis was made primarily by endoscopic biopsy, and treatment was initiated primarily by gastroenterologists. Several noninvasive office-based diagnostic tests are now readily available to primary care physicians. Measurement of serum antibodies against H pylori is probably the most commonly used noninvasive test, although it does not distinguish active from previous infection. Measurement of the H pylori antigen in the stool and breath tests using urea (labeled with C and C carbon) are more accurate determinants of active H pylori infection. Because of the availability of noninvasive tests, there is an increased role for the primary care physician in diagnosing and managing this disorder.
The need to retest patients for eradication of the bacteria after treatment has not been established. The success of bacterial eradication depends primarily on patient compliance and on antibiotic resistance, and it varies in different populations. Recurrence rates after confirmed eradication are less than 1% per year. In our community we had noted that some of our patients with previously treated H pylori infection who later required repeat endoscopy still had active infection, as determined by endoscopic biopsy. With the recent availability of the low-cost on-site C-labeled urea breath test, we began testing patients with previously treated H pylori infection to confirm eradication. A retrospective chart review was done to determine whether the incidence of failed treatment warranted recommending repeat testing of all patients cared for by our primary care physicians.
