H Pylori Test and Treat: Pros and Cons
In recent years, the “test and treat” model has become increasingly popular for the treatment of H pylori and other stomach illnesses.
What Test and Treat Means
The test and treat model was developed in order to help cut down on the health costs associated with dyspepsia (the medical term for chronic stomach pain and (or) indigestion).
The idea is that H pylori is behind most infections, so if someone comes to the doctor with stomach ulcer symptoms, it is much cheaper for the patient if the doctor opts straight for an H pylori test (and subsequent treatment if the test is positive) than it is for him to investigate for an ulcer.
Traditional Approach versus Test and Treat
In order to understand the test and treat approach, it is easier to compare it to the traditional approach to see how the treatment of ulcers and dyspepsia has changed.
- Patient reports to doctor with symptoms of dyspepsia or a peptic ulcer, such as stomach pain, indigestion, burning pain
- The doctor orders and endoscopy to investigate for the presence of ulcers or another abnormality
- If an ulcer was found, an H pylori test would be ordered
- If H pylori was found, then a treatment plan would be administered for its elimination, typically triple therapy
Test and Treat
- Patient reports symptoms of dyspepsia or ulcer, is otherwise relatively healthy (no symptoms of bleeding) and young (under 45-55; depending on various risk factors)
- Doctor orders H pylori test
- If H pylori test is positive (most of the time it is), triple therapy or another treatment plan is ordered
As you can see, the test and treat approach involves removing the endoscopy from the procedure as this saves the patient a lot of money and pain and suffering, as the end result is typically the same: H pylori infection is usually found and treated.
Results of Research
Several large-scale meta-analyses have been performed investigating the efficacy and cost of the test and treat procedure. One study found that there was no difference between the two treatments and remarked that physician and patient preference should decide (1). To the contrary, another group of researchers found that the Test and Treat model offered significant savings over the traditional approach, and an initial endoscopy for dyspepsia was not a cost effective solution (2).
The largest study found that while the traditional approach has slightly better results in the long-term, test and treat saved patients on average nearly $400 (3).
Test and Treat Conclusion
As a patient, you should discuss both options with your doctor. The major pro of an endoscopy is mildly increased accuracy (and hence more accurate treatment), with the major con of being expensive.
1. Mahadeva S, Chia YC, Vinothini A, Mohazmi M, Goh KL. Cost-effectiveness of and satisfaction with a Helicobacter pylori “test and treat” strategy compared with prompt endoscopy in young Asians with dyspepsia. Gut. 2008 Sep;57(9):1214-20.
2. Ford AC, Moayyedi P, Jarbol DE, Logan RF, Delaney BC. Meta-analysis: Helicobacter pylori’test and treat’ compared with empirical acid suppression for managing dyspepsia. Aliment Pharmacol Ther. 2008 Sep 1;28(5):534-44.
3. Ford AC., et al. Helicobacter pylori “test and treat” or endoscopy for managing dyspepsia: an individual patient data meta-analysis. Gastroenterology. 2005 Jun;128(7):1838-44.