Appropriateness of urea breath test (UBT) referrals in Italy according to the Maastricht 2000 guidelines of H. pylori infection.

Background: Urea breath test (UBT) is the most accurate non invasive test for either diagnosing (Dx) or confirming the successful eradication (Cx) of H. pylori infection. Aim: To evaluate the appropriateness of UBT referrals in one Italian Center. Methods: Patients consecutively referred for UBT (1-year period). Age, sex, symptoms, endoscopic findings, NSAIDs use, family history of gastric cancer or H. pylori infection, and concomitant diseases were recorded. Reasons for UBT referral were carefully examined and judged as appropriate or not according to the guidelines of the Maastricht 2-2000 Consensus Meeting. Patients were asked whether they had been referred by GP or gastroenterologist. Results: 1320 subjects (47±16 years) were referred for UBT to our Unit during 2001:578 (43.8%) for Dx and 742 (56.2%) for Cx of infection. The UBT was considered appropriate in 836 (63.3%) patients, inappropriate in 192 (14.5%), and still appropriate but avoidable in 292 (22.1%) patients who should have been tested with a biopsy-based method during prior endoscopy. In the subgroup of patients (n = 230) with uninvestigated dyspepsia, who underwent UBT according to the "test and treat" strategy proposed in Maastricht, 98 (42.6%) were > 45 years or presented at least one risk factor for organic disease. Overall, the appropriateness ratio of UBT referrals (appropriate UBT/inappropriate UBT) was 4.64 and 9.02 (p < 0.01) for GPs and gastroenterologists, respectively. Conclusion: In Italy, nearly 36% of UBT referrals are inappropriate or could be avoided if all dyspeptic patients with risk factors would be correctly referred to endoscopy or all dyspeptic patients undergoing endoscopy would be tested for H. pylori infection with a biopsy-based method. Although the European guidelines on the management strategies of H. pylori infection clearly indicate who to test and how to test, both GPs and, to a lesser extent, gastroenterologists still need educational programs to... [ABSTRACT FROM AUTHOR]