Validity of an epidemiologic instrument for H. pylori screening among dyspeptic patients
Autor(a) principal: | |
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Data de Publicação: | 2009 |
Outros Autores: | , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | por eng |
Título da fonte: | Revista de Saúde Pública |
Texto Completo: | https://www.revistas.usp.br/rsp/article/view/32646 |
Resumo: | OBJECTIVE:To validate an epidemiological score for identifying dyspeptic patients at high risk of being H. pylori positive. METHODS:Cross-sectional study including 434 users of primary health care units in the city of Pelotas, Southern Brazil, aged 18-45 years, and with symptoms of non-investigated dyspepsia, between 2006 and 2007. Dyspepsia was diagnosed according to Roma-II. The gold standard for H. pylori infection was the 13C-urea-breath-test. The association between presence of H. pylori and independent variables was assessed through Logistic Regression. The score was built based on adjusted odds ratios. Sensitivity, specificity, and predictive values of different cutoffs were calculated. RESULTS:Prevalence of H. pylori dyspeptic subjects was 74% (95% CI: 69;77.7). Prevalence was directly associated with age and number of siblings during childhood, and inversely associated with schooling; these variables were used in the construction of the score. The score ranged from 3 to 9 points. Scores 7, 8, and 9 had sensitivity of 36.6%, 22.3%, and 11.1%, and positive predictive values of 87.8%, 90.9%, and 92.1%, respectively. Without the score, 3 in every 4 dyspeptic patients would have received H. pylori erradication therapy. This proportion would have been lower with the score (one in three, six, and 11, for the cutoff points betwewen 7 and 9, respectively), albeit at the expense of a high rate of false-negatives. CONCLUSIONS:The score was not valid for selectively identifying dyspeptic individuals candidate to eradication therapy for H. pylori. Contrary to the recommendation in developed countries, the test-and-treat strategy seems inappropriate for use in developing settings due to the high prevalence of H. pylori infection. |
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Validity of an epidemiologic instrument for H. pylori screening among dyspeptic patients Validez del instrumento epidemiológico para rastrear H. pylori entre pacientes dispépticos Validade de instrumento epidemiológico para rastrear H. pylori entre pacientes dispépticos Helicobacter pyloriInfecções por Helicobacter^i1^sdiagnóstDispepsiaValidade dos TestesSensibilidade e EspecificidadeEstudos TransversaisHelicobacter pyloriInfecciones por Helicobacter^i3^sdiagnóstDispepsiaValidez de las PruebasSensibilidad y EspecificidadEstudios TransversalesHelicobacter pyloriHelicobacter Infections^i2^sdiagnoDyspepsiaValidity of TestsSensitivity and SpecificityCross-Sectional Studies OBJECTIVE:To validate an epidemiological score for identifying dyspeptic patients at high risk of being H. pylori positive. METHODS:Cross-sectional study including 434 users of primary health care units in the city of Pelotas, Southern Brazil, aged 18-45 years, and with symptoms of non-investigated dyspepsia, between 2006 and 2007. Dyspepsia was diagnosed according to Roma-II. The gold standard for H. pylori infection was the 13C-urea-breath-test. The association between presence of H. pylori and independent variables was assessed through Logistic Regression. The score was built based on adjusted odds ratios. Sensitivity, specificity, and predictive values of different cutoffs were calculated. RESULTS:Prevalence of H. pylori dyspeptic subjects was 74% (95% CI: 69;77.7). Prevalence was directly associated with age and number of siblings during childhood, and inversely associated with schooling; these variables were used in the construction of the score. The score ranged from 3 to 9 points. Scores 7, 8, and 9 had sensitivity of 36.6%, 22.3%, and 11.1%, and positive predictive values of 87.8%, 90.9%, and 92.1%, respectively. Without the score, 3 in every 4 dyspeptic patients would have received H. pylori erradication therapy. This proportion would have been lower with the score (one in three, six, and 11, for the cutoff points betwewen 7 and 9, respectively), albeit at the expense of a high rate of false-negatives. CONCLUSIONS:The score was not valid for selectively identifying dyspeptic individuals candidate to eradication therapy for H. pylori. Contrary to the recommendation in developed countries, the test-and-treat strategy seems inappropriate for use in developing settings due to the high prevalence of H. pylori infection. OBJETIVO:Validar un escore epidemiológico para identificar dispépticos positivos para Helicobacter pylori. MÉTODOS:Estudio transversal realizado con 434 individuos entre 18 y 45 años de edad, portadores de dispepsia no investigada, usuarios de unidades básicas de salud de Pelotas (Sur de Brasil), entre 2006 y 2007. Fue diagnosticada dispepsia conforme Roma-II. El patrón-oro para presencia de H. pylori fue la prueba respiratoria con 13C-urea. Se analizó la asociación entre H. pylori y variables independientes por regresión logística. El escore fue construido a partir de odds ratios ajustados. Fueron calculados la sensibilidad, especificidad y valores predictivos. RESULTADOS: Entre los dispépticos, la prevalencia de H. pylory fue 74% (IC 95%: 69; 77,7) y estuvo asociada directamente a la edad y número de hermanos en la infancia e inversamente a la escolaridad, siendo esas variables utilizadas en la construcción del escore. Los valores del escore variaron de 3-9. Escores entre 7, 8 y 9 presentaron sensibilidad, respectivamente, de 36,6%, 22,3% y 11,1%; y valores predictivos positivos 87,8%, 90,9% y 92,1%. Sin la aplicación del escore, tres de cada cuatro dispépticos recibirían tratamiento para H. pylori, con la aplicación, menor número de dispépticos serian encaminados para el tratamiento (uno de dada tres, seis y 11, respectivamente, con los puntos de corte entre 7 y 9) pero, a costa de una alta tasa de casos falso-negativos. CONCLUSIONES: El escore no fue validado para identificación selectiva de dispépticos candidatos al tratamiento erradicador para H. pylori. Diferentemente de lo recomendado para países desarrollados, la alta prevalencia de H. pylori torna la estrategia evaluar-y- tratar inapropiada para uso en los países en desarrollo. OBJETIVO:Validar um escore epidemiológico para identificar dispépticos positivos para Helicobacter pylori. MÉTODOS: Estudo transversal realizado com 434 indivíduos entre 18 e 45 anos de idade, portadores de dispepsia não investigada, usuários de unidades básicas de saúde de Pelotas (RS), entre 2006 e 2007. Dispepsia foi diagnosticada conforme Roma-II. O padrão-ouro para presença de H. pylori foi o teste respiratório com 13C-uréia. Analisou-se a associação entre H. pylori e variáveis independentes por regressão logística. O escore foi construído a partir de odds ratios ajustadas. Foram calculadas a sensibilidade, especificidade e valores preditivos. RESULTADOS: Dentre os dispépticos, a prevalência de H. pylori foi 74% (IC 95%: 69;77,7) e esteve associada diretamente à idade e número de irmãos na infância e inversamente à escolaridade, sendo essas variáveis utilizadas na construção do escore. Os valores do escore variaram de 3-9. Escores entre 7, 8 e 9 apresentaram sensibilidade, respectivamente, de 36,6%, 22,3% e 11,1%; e valores preditivos positivos 87,8%, 90,9% e 92,1%. Sem a aplicação do escore, três de cada quatro dispépticos receberiam tratamento para H. pylori, com a aplicação, menor número de dispépticos seriam encaminhados para tratamento (um em cada três, seis e 11, respectivamente, com os pontos de corte entre 7 e 9), porém às custas de alta taxa de casos falso-negativos. CONCLUSÕES:O escore não foi válido para identificação seletiva de dispépticos candidatos a tratamento erradicador para H. pylori. Diferentemente do recomendado para países desenvolvidos, a alta prevalência de H. pylori torna a estratégia testar-e-tratar inapropriada para uso nos países em desenvolvimento. Universidade de São Paulo. Faculdade de Saúde Pública2009-08-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttps://www.revistas.usp.br/rsp/article/view/3264610.1590/S0034-89102009005000034Revista de Saúde Pública; Vol. 43 No. 4 (2009); 639-646 Revista de Saúde Pública; Vol. 43 Núm. 4 (2009); 639-646 Revista de Saúde Pública; v. 43 n. 4 (2009); 639-646 1518-87870034-8910reponame:Revista de Saúde Públicainstname:Universidade de São Paulo (USP)instacron:USPporenghttps://www.revistas.usp.br/rsp/article/view/32646/35029https://www.revistas.usp.br/rsp/article/view/32646/35030Copyright (c) 2017 Revista de Saúde Públicainfo:eu-repo/semantics/openAccessSantos, Iná SilvaSassi, Raúl A MendozaMinten, Gicele CostaTuerlinckx, Giovana CostaValle, Neiva C JOliveira, Sandro S deBoccio, JoseBarrado, Domingo AndrésMariani, Samanta GaertnerCarriconde, Joaquim Freitas2012-07-09T02:05:27Zoai:revistas.usp.br:article/32646Revistahttps://www.revistas.usp.br/rsp/indexONGhttps://www.revistas.usp.br/rsp/oairevsp@org.usp.br||revsp1@usp.br1518-87870034-8910opendoar:2012-07-09T02:05:27Revista de Saúde Pública - Universidade de São Paulo (USP)false |
dc.title.none.fl_str_mv |
Validity of an epidemiologic instrument for H. pylori screening among dyspeptic patients Validez del instrumento epidemiológico para rastrear H. pylori entre pacientes dispépticos Validade de instrumento epidemiológico para rastrear H. pylori entre pacientes dispépticos |
title |
Validity of an epidemiologic instrument for H. pylori screening among dyspeptic patients |
spellingShingle |
Validity of an epidemiologic instrument for H. pylori screening among dyspeptic patients Santos, Iná Silva Helicobacter pylori Infecções por Helicobacter^i1^sdiagnóst Dispepsia Validade dos Testes Sensibilidade e Especificidade Estudos Transversais Helicobacter pylori Infecciones por Helicobacter^i3^sdiagnóst Dispepsia Validez de las Pruebas Sensibilidad y Especificidad Estudios Transversales Helicobacter pylori Helicobacter Infections^i2^sdiagno Dyspepsia Validity of Tests Sensitivity and Specificity Cross-Sectional Studies |
title_short |
Validity of an epidemiologic instrument for H. pylori screening among dyspeptic patients |
title_full |
Validity of an epidemiologic instrument for H. pylori screening among dyspeptic patients |
title_fullStr |
Validity of an epidemiologic instrument for H. pylori screening among dyspeptic patients |
title_full_unstemmed |
Validity of an epidemiologic instrument for H. pylori screening among dyspeptic patients |
title_sort |
Validity of an epidemiologic instrument for H. pylori screening among dyspeptic patients |
author |
Santos, Iná Silva |
author_facet |
Santos, Iná Silva Sassi, Raúl A Mendoza Minten, Gicele Costa Tuerlinckx, Giovana Costa Valle, Neiva C J Oliveira, Sandro S de Boccio, Jose Barrado, Domingo Andrés Mariani, Samanta Gaertner Carriconde, Joaquim Freitas |
author_role |
author |
author2 |
Sassi, Raúl A Mendoza Minten, Gicele Costa Tuerlinckx, Giovana Costa Valle, Neiva C J Oliveira, Sandro S de Boccio, Jose Barrado, Domingo Andrés Mariani, Samanta Gaertner Carriconde, Joaquim Freitas |
author2_role |
author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Santos, Iná Silva Sassi, Raúl A Mendoza Minten, Gicele Costa Tuerlinckx, Giovana Costa Valle, Neiva C J Oliveira, Sandro S de Boccio, Jose Barrado, Domingo Andrés Mariani, Samanta Gaertner Carriconde, Joaquim Freitas |
dc.subject.por.fl_str_mv |
Helicobacter pylori Infecções por Helicobacter^i1^sdiagnóst Dispepsia Validade dos Testes Sensibilidade e Especificidade Estudos Transversais Helicobacter pylori Infecciones por Helicobacter^i3^sdiagnóst Dispepsia Validez de las Pruebas Sensibilidad y Especificidad Estudios Transversales Helicobacter pylori Helicobacter Infections^i2^sdiagno Dyspepsia Validity of Tests Sensitivity and Specificity Cross-Sectional Studies |
topic |
Helicobacter pylori Infecções por Helicobacter^i1^sdiagnóst Dispepsia Validade dos Testes Sensibilidade e Especificidade Estudos Transversais Helicobacter pylori Infecciones por Helicobacter^i3^sdiagnóst Dispepsia Validez de las Pruebas Sensibilidad y Especificidad Estudios Transversales Helicobacter pylori Helicobacter Infections^i2^sdiagno Dyspepsia Validity of Tests Sensitivity and Specificity Cross-Sectional Studies |
description |
OBJECTIVE:To validate an epidemiological score for identifying dyspeptic patients at high risk of being H. pylori positive. METHODS:Cross-sectional study including 434 users of primary health care units in the city of Pelotas, Southern Brazil, aged 18-45 years, and with symptoms of non-investigated dyspepsia, between 2006 and 2007. Dyspepsia was diagnosed according to Roma-II. The gold standard for H. pylori infection was the 13C-urea-breath-test. The association between presence of H. pylori and independent variables was assessed through Logistic Regression. The score was built based on adjusted odds ratios. Sensitivity, specificity, and predictive values of different cutoffs were calculated. RESULTS:Prevalence of H. pylori dyspeptic subjects was 74% (95% CI: 69;77.7). Prevalence was directly associated with age and number of siblings during childhood, and inversely associated with schooling; these variables were used in the construction of the score. The score ranged from 3 to 9 points. Scores 7, 8, and 9 had sensitivity of 36.6%, 22.3%, and 11.1%, and positive predictive values of 87.8%, 90.9%, and 92.1%, respectively. Without the score, 3 in every 4 dyspeptic patients would have received H. pylori erradication therapy. This proportion would have been lower with the score (one in three, six, and 11, for the cutoff points betwewen 7 and 9, respectively), albeit at the expense of a high rate of false-negatives. CONCLUSIONS:The score was not valid for selectively identifying dyspeptic individuals candidate to eradication therapy for H. pylori. Contrary to the recommendation in developed countries, the test-and-treat strategy seems inappropriate for use in developing settings due to the high prevalence of H. pylori infection. |
publishDate |
2009 |
dc.date.none.fl_str_mv |
2009-08-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://www.revistas.usp.br/rsp/article/view/32646 10.1590/S0034-89102009005000034 |
url |
https://www.revistas.usp.br/rsp/article/view/32646 |
identifier_str_mv |
10.1590/S0034-89102009005000034 |
dc.language.iso.fl_str_mv |
por eng |
language |
por eng |
dc.relation.none.fl_str_mv |
https://www.revistas.usp.br/rsp/article/view/32646/35029 https://www.revistas.usp.br/rsp/article/view/32646/35030 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2017 Revista de Saúde Pública info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2017 Revista de Saúde Pública |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf application/pdf |
dc.publisher.none.fl_str_mv |
Universidade de São Paulo. Faculdade de Saúde Pública |
publisher.none.fl_str_mv |
Universidade de São Paulo. Faculdade de Saúde Pública |
dc.source.none.fl_str_mv |
Revista de Saúde Pública; Vol. 43 No. 4 (2009); 639-646 Revista de Saúde Pública; Vol. 43 Núm. 4 (2009); 639-646 Revista de Saúde Pública; v. 43 n. 4 (2009); 639-646 1518-8787 0034-8910 reponame:Revista de Saúde Pública instname:Universidade de São Paulo (USP) instacron:USP |
instname_str |
Universidade de São Paulo (USP) |
instacron_str |
USP |
institution |
USP |
reponame_str |
Revista de Saúde Pública |
collection |
Revista de Saúde Pública |
repository.name.fl_str_mv |
Revista de Saúde Pública - Universidade de São Paulo (USP) |
repository.mail.fl_str_mv |
revsp@org.usp.br||revsp1@usp.br |
_version_ |
1800221789504143360 |