PRE-ENDOSCOPY SCREENING USING SERODIAGNOSIS OF HELICOBACTER-PYLORI INFECTION

Objective: To determine the potential of Helicobacter pylori serodiagnosis using an enzyme-linked immunosorbent assay (ELISA) as a predictor of upper gastrointestinal endoscopy results. Patients: The study included 543 prospectively recruited patients referred for routine upper gastrointestinal endoscopy. Results: Detection of H. pylori infection by serology was compared with culture and histology in 259 patients, yielding 90% sensitivity and 86.7% specificity. For patients under 45 years of age, the sensitivity and negative predictive values were 100%. Of 138 patients under 45 years of age, 92 were seronegative, 29 of whom had endoscopic abnormalities. Analysis of site-specific clinical risk factors from questionnaire responses was suggestive of a correlation between smoking and alcohol consumption and oesophageal pathology (P=0.041 and 0.007, respectively), between history of peptic ulcer and gastric pathology (P=0.049), and between male sex and duodenal pathology (P=0.005). Positive serology significantly correlated with pathology at all sites and for all age groups (P=0.007, oesophagus; P=0.000, stomach; P=0.006, duodenum). Conclusion: Exclusion of H. pylori seronegative patients under 45 years of age would result in a 67% reduction in the endoscopy workload in this age group and a 17% overall reduction, whilst missing few abnormalities. Serodiagnosis of H. pylori using ELISA has potential as a screening strategy when applied to patients under 45 years of age by predicting normal upper gastrointestinal endoscopies.