Family history of peptic ulcer and a positive 13C urea breath test are predictive of gastroduodenal ulcer disease in uninvestigated dyspeptic patients

Background/Aim: H. pylori (HP) infection plays an important role in the pathogenesis of peptic ulcer disease. As dyspeptic symptoms are common in the general population, cost-effective strategies have attempted to substitute endoscopy with non-invasive tests for HP status. In this study we evaluated the ability of the 13C urea breath test and other risk factors to predict peptic ulcer disease. Methods: Patients referred to our Gastrointestinal Unit for investigation of dyspepsia were invited to take part in the study. Exclusion criteria were: previous dyspepsia workup, chronic treatment with NSAIDs and use (within the last month) of antibiotics, PPI, H2RA, bismuth preparations. Two hundred seven consecutive dyspeptic patients answered a standard questionnaire and were submitted to the 13C urea breath test and upper gastrointestinal endoscopy (FUJINON EG7-HR2). The Pearson Chi-square test, followed by Logistic regression analysis, was used to identify risk factors independently associated with peptic ulcer disease. Results: The study population included 118 HP-positive (mean age: 47:1: 13; M/F ratio=l.03) and 89 HP-negative (mean age: 38:1: 16; M/F ratio=l.02). Peptic ulcer disease (gastric or duodenal ulcer and erosive duodenitis) was found in 44 patients (21.3%), 37 HP-positive (31.4%) and 7 HP-negative (7.8%). HP infection (p < 0.0001), family history of peptic ulcer disease (p < 0.0001) and male sex (p < 0.005) were significantly associated with endoscopic findings of peptic ulcer disease. Logistic regression analysis revealed, however, that only the former two (OR=2.70, multivariate p < 0.001; OR=2.72, multivariate p < 0.0001, respectively) were significant independent predictors of peptic ulcer disease. Conclusions: Our results confirm that non-invasive H. pylori testing can predict gastroduodenal ulcer disease, particularly when the family history is positive for the latter. This fact should be considered in developing costeffective strategies for the workup of dyspepsia.