Community-Based Helicobacter pylori Screening in Patients with Endoscopic Evidence of Peptic Ulcer Disease

Abstract

Purpose: Identification of H. pylori (Hp) is important in the management of peptic ulcer disease (PUD) as treatment greatly reduces the risk of ulcer recurrence. Our study aimed to identify Hp screening rates in patients with PUD as well as differences in screening and treatment rates between three specialties performing endoscopies: Gastroenterology (GI), Surgery, and Family Practice (FP). Methods: Charts of 715 consecutive inpatients diagnosed with PUD on upper endoscopy in Wichita, KS were reviewed for Hp screening with biopsy or rapid urease testing, biopsy histology, culture, or PCR, fecal antigen, serology, salivary assay, or urea breath testing. Charts of Hp positive patients were reviewed for treatment with an approved regimen while hospitalized or documented plans for outpatient therapy. Comparisons between endoscopist specialties were made using chi-square analysis. Results: 76.9% (550/715) of patients with PUD diagnosed on upper endoscopy were screened for Hp. Of those patients screened, 16.4% (90/550) were Hp positive. While 63.3% (57/90) of Hp positive patients were treated during hospitalization, only 9.1% (3/33) of the remaining untreated patients had documented plans for outpatient treatment. Three endoscopies were performed by Internal Medicine physicians and were excluded from specialty analysis. GI performed 321 endoscopies and screened significantly more frequently [83.5% (268/321)] than surgery [72.1% (261/362)] who screened more frequently than FP [65.5% (19/29)] for Hp (x2 = 14.685; P= 0.001). No significant differences by age group or gender and type of specialty were identified. Comparison of treatment rates showed that GI treated Hp positive patients significantly more frequently [80.4% (37/46)] than surgery [50% (20/40)] with no FP patients (0/3) receiving treatment (x2 = 14.136; P= 0.001). Conclusion: While GI screened and treated Hp positive patients more frequently than other specialties, improvement is needed in both areas for all endoscopists. Patients not receiving inpatient treatment need well documented plans for outpatient therapy to ensure adequate follow-up of pending results. Rates of Hp were lower than expected indicating possible false negative test results. As identification and eradication of Hp are important in the prevention of recurrent PUD, potential sources for false negatives on initial Hp testing should be identified so that repeat testing may be performed as indicated.