Treating Gastritis, Peptic Ulcer Disease, and Dyspepsia in the Emergency Department: The Feasibility and Patient-Reported Outcomes of Testing and Treating for Helicobacter pylori Infection

Abstract

Helicobacter pylori infection is a known cause of gastritis, dyspepsia, and peptic ulcer disease. Testing for infection is indicated in high-prevalence outpatient settings. The objective of this prospective cohort study is to examine the feasibility of a test-and-treat strategy in the emergency department (ED) setting. During a 13-month period at an academic ED, symptomatic patients underwent a point-of-care urea breath test (BreathID; Exalenz Bioscience Inc., Modiin, Israel) during the ED visit. Research assistants abstracted treatment information from the electronic medical record. Patients who tested positive were prescribed triple-therapy medication. All enrollees were telephoned 2 weeks after the index ED visit to ascertain symptom resolution and treatment compliance. H pylori-positive subjects were asked to return to the ED for retest. Risk differences in patient and clinical characteristics were compared by Hpylori infection status, and a paired t test was used to estimate differences in pain resolution at the ED visit and follow-up. Of the 465 symptomatic patients, 271 were eligible and 212 enrolled and were tested for H pylori. Forty-nine patients (23%) (95% confidence interval [CI] 18% to 30%) had a positive result, 33 of 49 (67%) (95% CI 53% to 79%) self-reported receiving the medication as prescribed at follow-up, 23 of 49 (47%) (95% CI 34% to 61%) were retested, and 20 of 49 (41%) (95% CI 28% to 55%) had a negative result. There was a significant reduction in pain severity, regardless of H pylori infection status. A test-and-treat strategy is feasible in the ED setting and could benefit symptomatic patients.