Ahmed Ahmed, DO
Newark, New Jersey
Ahmed Ahmed, DO, Laura Rotundo, MD, Alejandro Silva, MD, Mirela Feurdean, MD, Suzanne Atkin, MD
Rutgers New Jersey Medical School, Newark, NJ
Introduction: Helicobacter pylori (HP) is a common gastric infection with the highest prevalence in Asia, Africa, Central, and South America as well as in U.S. immigrants from these areas. Current American College of Gastroenterology (ACG) guidelines recommend screening for HP in cases such as patients with active or prior peptic ulcer disease (PUD). However, screening is not recommended for patients who exhibit only symptoms of gastroesophageal reflux disease (GERD) irrespective of regional origin. The goal of this study was to determine if patients from endemic regions with GERD should be screened for HP.
Methods: This is a retrospective chart review of all patients who presented to an internal medicine ambulatory care clinic in 2017 with symptoms of GERD and/or PUD for whom orders were placed for HP testing via stool antigen or endoscopic biopsy. GERD symptoms were defined as reflux or heartburn and PUD as any symptom of dyspepsia. Patients were stratified by symptoms: GERD, PUD, or both. Exclusion criteria were as follows: tests ordered but never collected, orders for confirmation of cure for prior infection, multiple tests ordered for the same patient over the study period, tested patients with no symptoms, and patients with symptoms related to a non-H. pylori preexisting disorder. Enrolled patients were further stratified by region of origin.
Results: 122 patients that met the selection criteria were included in this study. 43% (52/122) of all patients were positive for HP. Of those that were positive, 92% (48/52) came from an endemic area (83% from South or Central America) and of these 75% (36/48) had PUD symptoms, 25% (12/48) had GERD only, and 52% (25/48) had both GERD and PUD symptoms. Of HP positive patients from non-endemic areas, all had GERD symptoms (4/4), with 1 having GERD only. Of patients that had GERD symptoms only, 25% (12/48) tested positive for HP and were from endemic areas.
Discussion: In our study, 25% of patients from endemic regions with solely GERD symptoms tested positive for HP, suggesting that recommendations for screening should include this population. Our data collection was small and skewed towards patients originating from endemic regions of South and Central America, and the results may not be applicable to other endemic regions, such as Asia and Africa. Further studies are needed to establish appropriate screening recommendations that are applicable to other endemic areas, so that the diagnosis of HP is not missed.
Citation: Ahmed Ahmed, DO, Laura Rotundo, MD, Alejandro Silva, MD, Mirela Feurdean, MD, Suzanne Atkin, MD. P1758 - EXPLORING THE POSSIBILITY OF GASTROESOPHAGEAL REFLUX DISEASE AS A SCREENING FACTOR FOR HELICOBACTER PYLORI IN PATIENTS FROM ENDEMIC REGIONS. Program No. P1758. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.