Physicians in primary care need a simple, convenient, inexpensive diagnostic test for active H. pylori infection that has a sensitivity, specificity, and predictive value of greater than 90%. In addition, they need a clear algorithm that defines criteria for testing symptomatic patients, criteria for diagnostic test selection, and criteria for treating and retesting patients. They also need to know when referral to a gastroenterologist is necessary for patients whose PUD develops complications or whose H. pylori infection does not respond to reasonable treatment.
Three important precepts in the diagnosis of H. pylori infection and PUD are:
Non-invasive testing should be limited to active H. pylori tests (those tests that detect active infection) only. Passive tests do not distinguish between currently active infection and past exposure or an infection that has been cured. All serologic antibody tests are passive tests, whereas the stool antigen test (HpSA ®) and urea breath test are active tests and indicate an active H. pylori infection .
Testing should precede treatment (no one should receive antibiotics without being tested for H. pylori infection first).
Testing should only be performed in patients who will be administered treatment.
Ideal diagnostic test for H. pylori in primary care:
Accurate diagnostic of active infection
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Sensitivity and specificity > 90%
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Positive and negative predictive values > 90%
Immediately available (in the office or clinical laboratory)
Rapidly completed
Inexpensive
Convenient for physician and patient
Harmless
Unaffected by prior or current antisecretory therapies
