Faecal H pylori test is best for dyspepsia

The faecal antigen test for Helicobacter pylori should be used when performing ‘test and treat’ in dyspepsia, say UK researchers.

A coloured scanning electron micrograph showing H pylori
A coloured scanning electron micrograph showing H pylori

The finding has led to calls for the test to be added to the quality framework.

The test-and-treat protocol has been suggested as part of a dyspepsia quality indicator for 2008/9 by the Primary Care Society for Gastroenterology (PCSG).

Research from Cardiff University has now shown that the faecal antigen test is more accurate and cost-effective than the urea breath test or serology.

A model of 1,000 virtual patients, who were allocated to each of the three tests, showed that faecal antigen tests had 968 true positive outcomes. In comparison, only 961 were recorded for the urea breath test and 903 when serology was used.

When this accuracy was considered alongside standard costs of each test, the faecal test proved most cost-effective at £17.84 per positive test. The equivalent cost for the urea breath test is £24.40 and £18.36 per positive test for serology.

Additionally, the urea breath test is difficult to perform and serology is unable to distinguish between previous and active H pylori infection, said the researchers.

If implemented, faecal antigen testing could improve cost-effectiveness of H pylori tests and help GPs boost patient compliance with test and treat, they added.

In turn, this would increase eradication of H pylori and reduce excessive use of proton pump inhibitors.

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