Point-of-care H. pylori testing feasible, could improve outcomes

Last Updated: 2015-04-03

By Anne Harding

NEW YORK (Reuters Health) - Testing for Helicobacter pylori in patients who present to the emergency department (ED) with abdominal pain, and treating those who test positive, is feasible and may improve patient outcomes, new findings show.

Guidelines from gastroenterology specialty groups recommend the test-and-treat approach for patients who have uninvestigated dyspepsia and no risk factors for gastric cancer or serious disease in outpatient settings where prevalence of H. pylori infection is above 10%, researchers write in Annals of Emergency Medicine, online March 24.

Previously, testing for H. pylori required an antibody test or endoscopy, lead author Dr. Andrew Meltzer from George Washington University in Washington, D.C., told Reuters Health by email.

"The test for H. pylori has not really been feasible in an emergency room setting," he said. However, a new point-of-care urea breath test (HP FasTest Breath ID TM, Exalenz Bioscience Inc., Modiin, Israel) is non-invasive and provides quick results.

To investigate whether the test-and-treat approach would be feasible using the new breath test, Dr. Meltzer and his team used it to screen 212 patients who presented to the ED with symptoms of gastritis, peptic ulcer disease, or dyspepsia. Forty-nine (23%) tested positive for H. pylori, and were prescribed triple-therapy medication.

The investigators were able to interview 157 of the patients about two weeks after their discharge from the ED. Thirty-three of the patients reported using the medication as prescribed. Twenty-three of the patients were retested for H. pylori at six weeks, with 20 testing negative.

Eradication based on intention-to-treat was 41%, while it was 61% for patients who reported complying with medical treatment, and 87% for those who reported medication compliance and returned for retesting.

Most patients reported improvement in their pain about three weeks after they first visited the ED, and reductions in pain were similar for patients who tested positive for H. pylori and those who did not. Patients who tested positive were 24% less likely to receive additional abdominal testing than were patients who tested negative.

Ideally, Dr. Meltzer and his colleagues write, patients tested in the ED would go to their primary care doctor or an outpatient gastroenterology office for retesting.

"The advantage of this over past therapies or past management is that essentially we are able to cure these patients of their symptoms and while these symptoms are generally not life threatening, they cause pain and discomfort for these patients, and are a source of many visits to the ER," Dr. Meltzer said. "In the past patients would have to stay on a PPI essentially indefinitely to keep their symptoms at bay, now we hope we can get the same or better results with the PPI plus a 10-day course of antibiotics."

Dr. Meltzer signed a limited consulting agreement with Exalenz after data collection was complete. The National Institutes of Health National Center for Research Resources funded the study.

SOURCE: http://bit.ly/1EQu7AC

Ann Emerg Med 2015.