Point-of-care Helicobacter pylori testing: primary care technology update.

Abstract

#### Clinical Question In adults attending primary care with upper gastrointestinal symptoms, what is the accuracy and utility of point-of-care testing to detect Helicobacter pylori infection? Helicobacter pylori (HP) infection causes approximately 5% of uninvestigated dyspepsia and a 20% lifetime risk of peptic ulcer disease.1 HP is a grade 1 carcinogen: 5.2% of cancers globally are attributable to HP infection.2 HP eradication results in: reduced gastric cancer incidence; prevention of recurrent duodenal (number needed to treat [NNT] = 2) and stomach (NNT = 3) ulceration; and resolution of dyspepsia (NNT = 13).3 Non-invasive Helicobacter pylori diagnostic tests are available for point-of-care (POC) use in primary care and include IgG serology, 13C-urea breath test (UBT), and monoclonal stool antigen. Only UBT is sufficiently accurate to confirm current infection or eradication.4 HP IgG serology cannot differentiate current from past infection. Rapid qualitative stool antigen testing currently lacks diagnostic accuracy. Isotope ratio mass spectrometry (IRMS) is the most commonly used 13C-UBT method in the UK. However, the sampling procedure involves many opportunities for test incompletion: collection of the test from the pharmacy; returning for a subsequent extended appointment; sending the test to the laboratory; and awaiting results. In comparison, non-dispersive isotope selective infrared spectroscopy (NDIRS) has potential as a POC device: it can be used by non-specialist staff outside the laboratory setting, it …