The Predictive Performance of Contemporary Guideline Recommendations for Helicobacter pylori Testing in a United States Population

Authors

Theresa Nguyen Wenker
Frederick B Peng
Ikenna Emelogu
Niharika Mallepally
Fasiha Kanwal
Hashem B El-Serag
Mimi C Tan

Publication Date

7-1-2023

Journal

Clinical Gastroenterology and Hepatology

DOI

10.1016/j.cgh.2022.10.009

PMID

36270616

PMCID

PMC10110767

PubMedCentral® Posted Date

7-1-2024

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Humans, Dyspepsia, Ethnicity, Helicobacter Infections, Helicobacter pylori, Hispanic or Latino, Risk Factors, United States, Black or African American, Emigrants and Immigrants, Predictive Value of Tests

Abstract

BACKGROUND: The Houston Consensus Conference and American College of Gastroenterology (ACG) have recommended Helicobacter pylori screening in United States populations with specific risk factors. However, the performance of these guidelines in clinical practice is not known.

METHODS: We identified consecutive patients undergoing upper endoscopy with gastric biopsies for any indication in a safety-net hospital in Houston, TX during January 2015-December 2016. We tested the association between the presence of H pylori (histopathology, stool antigen, urea breath test, immunoglobulin G serology, or prior treatment) and H pylori risk factors using logistic regression models, reported as odds ratios and 95% confidence intervals (CIs). We evaluated the area under the receiver operating characteristic (AUROC) curve for predictive ability of individual risk factors identified by the Houston Consensus Conference and ACG.

RESULTS: Of 942 patients, the prevalence of H pylori infection was 51.5%. The risk factors with the highest predictive performance included first-generation immigrant (AUROC, 0.59) and Hispanic or black race/ethnicity (AUROC, 0.57), whereas the remaining 7 risk factors/statements had low predictive value. A model that combined first-generation immigrant status, black or Hispanic race/ethnicity, dyspepsia, and reflux had higher predictive ability for H pylori infection (AUROC, 0.64; 95% CI, 0.61-0.68) than any individual risk factor.

CONCLUSIONS: In this contemporary U.S. cohort, the performance of individual risk factors identified by the Houston Consensus Conference and ACG was generally low for predicting H pylori infection except for black or Hispanic race/ethnicity and first-generation immigrant status. A risk prediction model combining several risk factors had improved diagnostic performance and should be validated in future studies.

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