Objectives: Helicobacter pylori (HP) infection is responsible of epigastric pain and dyspepsia. Many people suffering from HP infection experience acute retrosternal pain similar to a heart attack, and they access the Emergency Department (ED). The aim of this study is to evaluate the prevalence of HP infection in patients accessing the ED for epigastric/chest pain and/or dyspepsia in the absence of alarm symptoms, and to demonstrate the efficacy and utility of a rapid 13C-Urea Breath Test (UBT) directly in the ED.

Patients and Methods: We enrolled 101 consecutive patients (43M/58F, mean age 41.8 ± 15.9) who came to the ED of Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome with epigastric pain and dyspepsia. We excluded patients with chronic use of PPI, and recent use of antibiotics or antacids. Patients, in addition to the normal diagnostic protocol for epigastric pain, performed a UBT for the rapid diagnosis of HP.

Results: 36/101 (35.6%) patients resulted positive to HP infection, with a mean delta over the baseline (DOB) of 28.2 ± 11.3. All other exams were negative for 31/36 (86.0%) HP positive patients. Among the HP negative patients, 6/65 (9.3%) had gallbladder’s stones, 3/65 (4.6%) had electrocardiogram (EKG) abnormalities, 2/65 (3.1%) had a pancreatitis, 3/65 (4.6%) had a pneumonia, 5/65 (7.7%) had gastroenteritis, 16/65 (24.6%) musculoskeletal pain and 28/65 (43.1%) had reflux disease. The use of UBT in ED had a positive predictive value of 91.3%, with a sensitivity of 100% and a specificity of 95% in the detection of HP infection in patient with epigastric pain compared to other etiologies of epigastric pain.

Conclusions: The use of the UBT in patients accessing the ED for epigastric/chest pain and/or dyspepsia, in absence of alarming symptoms, allows obtaining a rapid, reliable and non-invasive diagnosis of HP infection as a responsible cause for the symptoms. This allows an early diagnosis and the prescription of an eradication therapy at the time of discharge, reducing ED overcrowding and the relative costs.