Multicenter Evaluation of Helicobacter pylori IgG Antibody Seroprevalence Among Patients Seeking Clinical Care in the US

Background: Current American College of Gastroenterology (ACG) guidelines suggest that Helicobacter pylori serologic testing may be helpful to rule out H. pylori in areas with low disease prevalence. However, even in low prevalence regions, the positive predictive value of a positive serologic result remains low. Additionally, both the ACG and the American Gastroenterological Association recommend that this noninvasive testing be avoided entirely for patients 55 years and older. Methods: The objective of this multicenter retrospective study was to assess H. pylori seroprevalence rates among symptomatic patients and serologic test utilization at the local, state, and national level. Submitted specimens were presumed to be collected from patients with upper gastrointestinal symptoms suspicious for an H. pylori etiology. Results for H. pylori IgG serologic tests performed between 2005 and 2014 were collected from 5 medical centers. Data were evaluated in the context of professional practice guidelines, with a focus on patients ages 55 years and older. Results: Nationwide seropositivity among symptomatic individuals is approximately 25%, and 4 of 5 centers reported decreasing seropositivity rates over this 10-year period. State-specific seropositivity among symptomatic patients ranged from 12.4% in the state of Washington to 33.9% in Mississippi. Conclusions: We demonstrate that for 48 states >25% of all H. pylori serologic testing was performed in individuals ≥55 years. Despite recommendations to avoid serologic evaluation for H. pylori infection, this study indicates that serology continues to be used at high rates across age-groups.