Predictive Ability of H. Pylori Risk Factors Reviewed

With the exception of Black or Hispanic race/ethnicity and first-generation immigrant status, individual Helicobacter pylori (H. pylori) risk factors identified by the Houston Consensus Conference and American College of Gastroenterology (ACG) demonstrated low performance for predicting infection in a US cohort, according to study findings published online in Clinical Gastroenterology and Hepatology.

“The Houston Consensus Conference and American College of Gastroenterology have recommended H. pylori screening in United States populations with specific risk factors. However, the performance of these guidelines in clinical practice is not known,” explained corresponding author Mimi C. Tan, MD, of the Baylor College of Medicine, Houston, Texas, and coauthors in the study background.

To gain insight into the real-world predictive performance of the recommendations, the study focused on 942 patients at a Houston hospital who underwent upper endoscopy with gastric biopsy for any indication in 2015 and 2016. Researchers looked at the association between specified risk factors and the actual presence of H. pylori infection, which occurred in 51.5% of the patients.

First-generation immigrant and Hispanic or Black race/ethnicity were the risk factors with the highest predictive ability. Researchers reported an area under the receiver operating characteristic curve (AUROC) of 0.59 for first-generation immigrant status and 0.57 for Hispanic or Black race/ethnicity. The predictive value of the 7 remaining risk factors was low.

However, combining first-generation immigrant status, Black or Hispanic race/ethnicity, dyspepsia, and reflux into one model achieved an AUROC of 0.64 for predictive ability, researchers reported.

“A risk prediction model combining several risk factors had improved diagnostic performance,” they advised, “and should be validated in future studies.”

—Jolynn Tumolo

Reference:
Wenker TN, Peng FB, Emelogu I, et al. The predictive performance of contemporary guideline recommendations for Helicobacter pylori testing in a United States population. Clin Gastroenterol Hepatol. Published online October 18, 2022.   DOI: 10.1016/j.cgh.2022.10.009