Predicting ulcer disease in dyspeptic patients by H. Pylori testing rather than endoscopy

To validate accuracy of the Rapid Blood Test [RBT] in predicting peptic ulcer disease in dyspeptic patients. Rationale: Most patients with dyspepsia have no pathology at endoscopy, thus are exposed to unjustified risk, cost, and inconvenience associated with this invasive assessment. Setting: Medical World Polyclinic and Dar Al-Shefa Hospital, Riyadh, KSA. Patients: One hundred patients with ulcer- like dyspepsia. All patients underwent a RBT followed by endoscopy with antral biopsies for histology and urease slide test [CLO test]. Sixty-five% of the patients were "gold standard" H. pylori positive [positive CLO test, positive histology], 30% were "gold standard" negative [negative CLO test, negative histology], and 5% had conflicting CLO test and histology results. Patients with peptic ulcer disease included 31% of all dyspeptic patients, 42% of H pylori-infected patients, and 7% of non-infected individuals. RBT could determine H. pylori status with a sensitivity of 91% and specificity of 77%. Positive and negative predictive values of the test were 89% and 79% respectively. In predicting peptic ulcer disease, RBT was sensitive in 93% of patients and specific in 41%. Positive and negative predictive values of the test were 41% and 93% respectively. Conclusions: RBT is reliable in determining H. pylori status. However, we cannot predict the development of peptic ulcer disease merely on the presence or absence of H. pylori