Approach, attitudes, and knowledge of general practitioners in relation to Helicobacter pylori is inadequate. There is much room for improvement!

Cano-Contreras, A.D.; Rascón, Oscar Cuauhtémoc Aguilar; Amieva-Balmori, Mercedes; Ríos-Gálvez, S.; Maza, Y.J.; Meixueiro-Daza, Arturo; Roesch-Dietlen, F.; Remes-Troche, J.M.

doi:10.1016/j.rgmxen.2017.08.005

Cited by 14 publications

(25 citation statements)

References 10 publications

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“…The most common inappropriate indication was gastroesophageal reflux (GERD). These figures are similar to those reported previously in other countries . In a Mexican study, 41.8% of PCPs reported that GERD was an indication for H pylori eradication, and 64% of PCPs in a study carried out in Pakistan also requested testing to detect H pylori infection in patients with GERD.…”

Section: Discussionsupporting

confidence: 86%

“…Today, most patients infected with H pylori are managed at the primary care level, and available studies suggest low adherence to guideline recommendations at this patient care level. 14,15 Our healthcare area provides an open-access urea breath test (UBT) service to PCPs, which, as reported in other studies, 14 has implied a progressive and large increase in the requests for UBT. Due to this lack of evidence, we conducted a study to evaluate and compare the most important outcomes involved in the management of H pylori infections between PCPs and gastroenterology specialists (GSs) and to evaluate the effect of introducing specific counseling at the individual level for PCPs when patients test positive for H pylori.…”

mentioning

confidence: 89%

“…The outcomes of this approach outside of the specialist and in real clinical life have not been well investigated. Today, most patients infected with H pylori are managed at the primary care level, and available studies suggest low adherence to guideline recommendations at this patient care level …”

Section: Introductionmentioning

confidence: 99%

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Management of Helicobacter pylori infection at the primary care level. The implementation of specific counseling improves eradication rates

et al. 2019

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Background Management of Helicobacter pylori infection has been expanded from the gastroenterology specialist (GS) to primary care physicians (PCPs), with a large increase in requests for urea breath tests (UBT). Due to the lack of evidence at this level, we evaluated the appropriateness of UBT indications and treatment for H pylori infections between PCPs and GSs and the effect of introducing specific counseling to PCPs. Materials and Methods This was a quasi‐experimental study. Phase I included 650 consecutive UBT requested by PCPs (400) and GSs (250). Indications and treatments were classified as appropriate or inappropriate based on national guidelines. Data on eradication rates were also collected. In phase II, 240 UBT and patients' treatment outcomes were analyzed after individually counseling PCPs on both aspects. Results Of 1049 UBT, inappropriate indications in phase I were significantly higher in tests requested by PCP compared with GS (35.9% vs 7.2%; P < 0.001). Inappropriate treatment regimens were significantly higher for PCPs in phase I (65.8% vs 26.4%; P < 0.001). Consequently, eradication rates were significantly lower in patients treated by PCPs compared with those treated by GS (63.7% vs 81.4%; P = 0.004). A significant increase in adherence to appropriate treatment regimens (75.8% vs 34.2%; P < 0.001) and eradication rates (79.2% vs 63.7%; P = 0.002) were observed in the PCP group after counseling; however, the appropriateness of indications did not improve. Conclusions Patients infected with H pylori managed at the primary care level had poorer outcomes. The introduction of specific counseling for PCPs significantly improved treatment management, but not indications.

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Section: Discussionsupporting

confidence: 86%

mentioning

confidence: 89%

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Management of Helicobacter pylori infection at the primary care level. The implementation of specific counseling improves eradication rates

et al. 2019

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“…Several similar studies had been carried out in other geographical locations showed <60% of the physicians would confirm H pylori eradication after treatment . Even if some of the findings are recently published from Mexican general practitioners and national gastroenterology physicians in the United States . In this study, the eradication effect after the treatment of H pylori was not confirmed accurately by all respondents, which was < 75%.…”

Section: Discussioncontrasting

confidence: 63%

“…Indeed, the consensus on the management of H pylori infection largely regulates the practice of clinicians, particularly in the developing world. However, some published surveys from several developed countries have revealed that significant confusion still exists and discrepancies are present in the understanding of H pylori infection management among primary care physicians . For instance, a recent survey in Germany showed only 11% of 188 physicians know the current clarithromycin resistance rates, and 26% do not control the success of first‐line eradication therapy …”

Section: Introductionmentioning

confidence: 99%

Management of Helicobacter pylori infection by clinicians: A nationwide survey in a developing country

et al. 2019

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Background & Aims Developing countries are making efforts to improve health management. Practice deviating from the guideline means inefficient control. The study aims to investigate the management of Helicobacter pylori (H pylori) infection from a developing country perspective. Methods An authoritative survey was conducted in 14th (2014) and 17th (2017) Congress of Gastroenterology China, respectively. The Maastricht V/Florence consensus report was invoked as the evaluation criterion. Results A total of 4182 valid samples were included in this study. Most of the respondents (94%) updated knowledge by lectures. Respondents had a different awareness rate of H pylori‐related diseases, ranging from 45% to 95%. Up to 40% of the respondents did not follow the recommendations for the diagnosis. Choice accuracy of eradication regimens and antibiotic combinations was <70%. About 20% of the respondents did not pay attention to the confirmation after the eradication. The situation had been improved in 2017 when compared with that in 2014 (all P < .05). Multivariate logistic regression analysis revealed that influencing factors including nongastroenterologists, bachelor degree and below, the primary professional title, hospital location, and a small proportion of H pylori infection in daily practice related to the deviation of consensus (all P < .05). Conclusions Although the management of H pylori infection has been improved in a developing country, there is still a gap between the real‐world practices and the consensus. Influencing factors should be taken into account in decision‐making, and the corresponding population should be strengthened with precision training during the promotion of the guideline.

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Adherence to Maastricht V/Florence consensus report for the management ofHelicobacter pyloriinfection among primary care physicians and medical students in Croatia: A cross‐sectional study

et al. 2020

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Background Helicobacter pylori (H pylori) eradication is becoming increasingly difficult. The aim of our study was to determine the knowledge of current guidelines and attitude in the diagnosis and treatment of H pylori infection in primary care physicians (PCPs) and medical students in Croatia. Materials and Methods A study was conducted among PCPs and medical students to evaluate adherence to Maastricht V consensus guidelines. Questionnaire was distributed by e‐mail to 2338 PCPs offices in Croatia and to the medical students from the University of Split School of Medicine. Responses were collected electronically from June 22 to August 22, 2020. Results Two hundred forty‐nine PCPs and 169 medical students were included in the study. Bismuth or non‐bismuth‐based quadruple therapy as first‐line treatment for H pylori was the choice of 4.8% of PCPs and 13% of students, while 66.3% PCPs and 79.9% students would choose clarithromycin‐based triple therapy. Bismuth‐based quadruple therapy was the most preferred second line of treatment for 45.4% of PCPs and 34.9% of students. Only 2.8% PCPs and 7.1% of students would correctly recommend first and second line of treatment for H. pylori infection. A larger proportion of students than PCPs would prefer C13‐urea breath test (50.3% vs 6.4%). Only 59.0% PCPs would treat for H pylori in all patients including the asymptomatic ones. Students more frequently recognized the link between H pylori and gastric cancer compared with PCPs (92.9% vs 73.5%). Conclusions Primary care physicians and medical students’ knowledge of H pylori guidelines are insufficient in Croatia and ask for additional training.

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Approach, attitudes, and knowledge of general practitioners in relation to Helicobacter pylori is inadequate. There is much room for improvement!

Cited by 14 publications

References 10 publications

Management of Helicobacter pylori infection at the primary care level. The implementation of specific counseling improves eradication rates

Management of Helicobacter pylori infection at the primary care level. The implementation of specific counseling improves eradication rates

Management of Helicobacter pylori infection by clinicians: A nationwide survey in a developing country

Adherence to Maastricht V/Florence consensus report for the management ofHelicobacter pyloriinfection among primary care physicians and medical students in Croatia: A cross‐sectional study

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