Nurse-led dyspepsia clinic using the urea breath test for Helicobacter pylori

Abstract

Aim: To audit the results of a nurse-led dyspepsia clinic. Methods: Referrals to the Gastroenterology Department at Auckland Hospital for gastroscopy were assessed in a dyspepsia clinic. Initial evaluation included consultation and a urea breath test (UBT). Patients given eradication treatment prior to initial clinic assessment were excluded. Patients with a positive UBT were given eradication treatment and were reviewed two months later for symptom assessment and follow-up UBT. Patients with a negative UBT were usually referred back to the GP. Results: There were 173 patients; mean age 38 years; 73 had a positive UBT (42%). A positive UBT was significantly associated with place of birth (NZ 16%; other place of birth 60%; p = 0.001). If the dominant symptom was epigastric pain 54% had a positive UBT; if it was reflux or bloating 29% were positive, p= 0.005. Forty nine UBT-positive patients had follow-up data and of these 43 had successful eradication (88%). Of patients with successful eradication, 40% had an excellent response, 38% improved, and 22% were not improved. After a mean follow up of 3.3 years 42/173 (24%) patients had a gastroscopy. Of these, 30 were initially UBT negative and 12 were UBT positive (9 had been successfully eradicated). The endoscopic findings were normal in 27, reflux oesophagitis in 13, pyloric stenosis in one, and gastric ulcer (HP+ve) in one. Helicobacter pylori status by biopsy was consistent with the UBT result. One hundred and thirteen patients also had H. pylori serology (Cobas Core, Roche) performed. There were three false negatives (negative predictive value of 94% [51/54]) and seven false positives (positive predictive value of 88% [52/59]). Conclusions: The urea breath test was found to be useful as part of the initial assessment of selected patients who would otherwise have been referred for endoscopy. It is likely that the need for gastroscopy was reduced, but longer follow up will be required to determine whether or not this effect is simply due to delayed referral. This approach is likely to have value only in patients who have a relatively high chance of being H. pylori positive.