Do urea breath test (UBT) referrals for Helicobacter pylori testing match the clinical guidelines in primary care practice? A prospective observational study

Abstract

Background: Various international guidelines recommend the use of non-endoscopic tests [such as urea breath test (UBT)] for the evaluation of dyspeptic patients, unless endoscopy is clinically indicated. Aim: To assess adherence with guidelines for UBT referrals among primary care doctors in Israel. Methods: Patients referred by primary care doctors to an open-access UBT service were included in the study. Prior to the test, all patients were administered with a short questionnaire regarding their symptoms, previous and concomitant medications including previous Helicobacter pylori eradication. Results: The study sample consisted of 209 patients, aged 18-94 years, M/F = 74/135. The UBT was judged to be appropriate in 94 (45%) subjects, inappropriate in 93 (44.5%) subjects and appropriate but avoidable in 22 (10.5%) subjects, most of them asymptomatic patients following anti H. pylori treatment. The inappropriate indications include 38 (18%) patients with suspected gastro-oesophageal reflux disease symptoms and 21 (10%) dyspeptic patients aged 45 years or more. Conclusion: Nearly 45% percent of UBT referrals in primary care practice were inappropriate, and a significant number of dyspeptic patients should have been referred to endoscopy. These findings show a substantial non-compliance with guidelines for H. pylori testing among primary care doctors. © 2008 The Authors.