Chapter III Helicobacter pylori testing in dyspeptic patients suspected of peptic ulcer disease in primary care; development of a simple diagnostic scoring rule

نویسندگان

  • Catherine F Weijnen
  • Mattijs E Numans
  • Niek J de Wit
  • André JPM Smout
  • Karel GM Moons
  • Theo JM Verheij
  • Arno W Hoes
چکیده

Objectives: To develop an easy applicable diagnostic scoring rule to determine the presence of peptic ulcers in dyspeptic patients in the primary care setting, and to evaluate whether Helicobacter pylori (H pylori) testing has added value to optimal history taking. Design: Cross-sectional study. Setting: Patients selected from general practitioner’s offices in the area of Utrecht, the Netherlands. Participants: 565 primary care patients consulting the general practitioner with dyspeptic complaints lasting at least two weeks. 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 using multivariable 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% CI 2.6-11.8), 2.8 (95% CI 1.0-4.0) and 2.0 (95% CI 1.4-6.0), respectively. The ROC area of these determinants together was 0.71. Adding the H pylori test increased the ROC area to only 0.75. However, in a high-risk patient group, 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 in diagnosing peptic ulcer disease. In a subgroup of patients at high risk for having peptic ulcer disease, however, it might be useful to test-and-treat for H pylori infections. Hp diagnostic scoring rule 45

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تاریخ انتشار 2002