P151 Could H Pylori testing reduce the number of patients unnecessarily referred on the upper GI suspected cancer pathway?

• Published in: Gut Vol. 72; no. Suppl 2; pp. A134 - A135
• Main Authors: Morgan, Hannah, Guthrie, Sarah, Jafar, Wisam, Miller, Bethany, McNamara, Patrick, Morgan, James
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 18.06.2023; BMJ Publishing Group LTD
• Subjects: Diagnosis; Dyspepsia; Dysphagia; Esophagitis; Gastric cancer; Gastritis; Helicobacter pylori; Infections; Pain; Peptic ulcers; Poster presentations; Vomiting
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2023-BSG.222

IntroductionHelicobacter pylori (H Pylori) is a common gastrointestinal (GI) infection that is associated with gastritis, peptic ulcer disease (PUD) and gastric cancer. Infection with H Pylori and the development of associated complications can lead to symptoms that may mimic those of oesophageal or stomach cancer and may prompt referral for urgent oesophago-gastro-duodenoscopy (OGD) under the NHS upper GI suspected cancer pathway NG12 (NICE, 2015) even in patients who do not meet specific referral criteria. This could result in unnecessary endoscopies being undertaken, increasing endoscopist workload and the NHS carbon footprint.We hypothesized that a proportion of symptoms prompting referral could be attributed to H Pylori infection. Some of these referrals and subsequent OGDs could have been avoided if H Pylori testing had been undertaken in the first instance.MethodWe undertook a retrospective evaluation of all suspected cancer referrals made within Stockport NHS Foundation Trust from 11/12/2019 – 06/12/2021. Details of the referral and the OGD results were recorded, including any positive H Pylori tests.Results2396 patients were referred and 2136 patients underwent an OGD. of these patients, 151 (7%) had a positive H Pylori test. Symptoms and diagnoses of patients with H Pylori are shown in table 1.Abstract P151 Table 1 Diagnoses of patients with H Pylori Diagnosis Gastritis Normal Oesophagitis PUD Gastric Cancer Other diagnosis Number of patients (%) 76 (50%) 21 (14%) 13 (8%) 11 (7%) 1 (1%) 29 (19%) Symptoms of patients with H Pylori Dysphagia Upper Abdominal Pain Dyspepsia Reflux Nausea & Vomiting Anaemia Number of patients (%) 65 (43%) 51 (34%) 50 (33%) 40 (26%) 26 (17%) 8 (5%) 800 (33%) patients referred did not meet the NICE criteria for the suspected cancer pathway. of the 726 that underwent OGD, 63 (9%) of these patients had H Pylori. of the 1596 patients that did meet NICE criteria, 88 (5%) had H Pylori. of the 151 patients with H Pylori, 26 (17%) patients did not meet the upper GI 2WW referral criteria. None of these patients had a cancer diagnosis made on OGD.ConclusionSeveral patients being referred under the upper GI suspected cancer pathway had a positive diagnosis of H Pylori, which was associated with dysphagia, upper abdominal pain, dyspepsia and reflux. 17% of these patients did not meet the NICE criteria for suspected cancer referral and may not have required OGD if they had been tested and treated for H Pylori initially. H Pylori was diagnosed more frequently in patients who did not meet NICE criteria than in those who did. Testing for H Pylori in patients with upper GI symptoms outside of NICE criteria may reduce the number of OGDs being carried out and should be added to the NICE pathway for this cohort.