Eradication of <i>Helicobacter pylori</i> in general practice

Penston, J. G.; Mistry, Khaylen

doi:10.1046/j.1365-2036.1996.745128000.x

Cited by 39 publications

(23 citation statements)

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“…Over the past decade many different therapies were promoted and recommendations changed rapidly. Most doctors lost track, and a great variety of treatments is being used 9. In this article we will try to provide a basic framework on which treatment can be based.…”

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confidence: 99%

Regular review: Treatment of Helicobacter pylori infection

Boer¹,

Tytgat²

2000

BMJ

175

139

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confidence: 99%

Regular review: Treatment of Helicobacter pylori infection

Boer¹,

Tytgat²

2000

BMJ

175

139

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“…Many community physicians are treating patients on the basis of such tests 12. Referral for endoscopy may be reserved for those with persisting, recurrent, or altered symptoms or at the discretion of the responsible physician.…”

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confidence: 99%

Gastric cancer and other endoscopic diagnoses in patients with benign dyspepsia

Breslin

2000

Gut

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Background-It has been suggested that endoscopy could be replaced with noninvasive assessment of helicobacter status in the initial work up of young dyspeptic patients without sinister symptoms. Aims-To determine the incidence of gastro-oesophageal malignancy in young dyspeptic patients. Methods-The Alberta Endoscopy Project captured clinical and demographic data on all endoscopies performed from April 1993 to February 1996 at four major adult hospitals in Alberta. The endoscopic and histological diagnosis in a subgroup of patients under 45 years of age without alarm symptoms that had undergone gastroscopy was reviewed. In addition, a random list of 200 patients was generated and their medical records reviewed in order to assess the proportion with symptoms suitable for a non-invasive management strategy. Results-Gastroscopy was performed in 7004 patients under 45 years. In 3634 patients (56% female) alarm type symptoms were absent; 78.9% of patients had symptoms amenable to a non-invasive initial approach, giving a corrected sample size of 2867 patients (correction factor 0.789). Three gastric cancers, one case of moderate dysplasia, 10 biopsy proved cases of Barrett's oesophagus, and 19 oesophageal strictures/rings were detected within this sample. The corrected prevalence of gastric cancer in this select population was 1.05 per thousand patients. Discussion-Endoscopy yielded three gastric cancers in this sample of under 45 year old dyspeptic patients without sinister symptoms. While initial non-invasive screening with one-week triple therapy for helicobacter positive individuals is unlikely to have a detrimental outcome the physician is advised to consider endoscopy in patients with persisting, recurrent, or sinister symptoms. (Gut 2000;46:93-97)

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“…HP eradication in patients with peptic ulcer disease is reported to be far from optimal [14], and general practitioners (GPs) use a wide spectrum of eradication therapies and regimens [15, 16]. Obviously, follow-up of many guidelines is limited.…”

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confidence: 99%

Dyspepsia Management in Primary Care in The Netherlands: To What Extent Is Helicobacter pylori Diagnosis and Treatment Incorporated?

Weijnen

Wit²,

Numans³

et al. 2001

Digestion

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Background: Many guidelines on the management of Helicobacter pylori (HP)-related dyspepsia have been launched over the past decade. The suggested policies in these guidelines are often more consensus- than evidence-based (test-and-treat policy, test and endoscope), which may cause confusion among primary-care physicians. Aim: To determine the current management of HP-related dyspepsia by Dutch general practitioners (GPs). Methods: A random sample of 5% of all Dutch GPs (n = 355) were sent a questionnaire on the diagnosis and treatment of HP infections in dyspepsia management. Results: The response rate was 66.2% (n = 235). Almost 80% of the responding GPs stated they had conducted HP testing (via endoscopy or serology) during the previous 12 months. In the same time period, more than 94% had actually prescribed a HP eradication therapy. A total of 70% of the GPs stated that they used endoscopy to test for HP infection, 54% used serology (ELISA); whole-blood tests and carbon urea breath tests were not used. Patients with a history of peptic ulcer disease, those on chronic acid-suppressive drugs and patients with recurrent ulcer-like complaints were most frequently tested for HP infection. Conclusions: Given the frequency of consultations for dyspepsia in primary care in the Netherlands (150 new dyspeptic patients per average practice per year), and the reported average number of HP tests perfomed (1–5 per GP per year), HP diagnosis plays a modest role in the management of dyspepsia in Dutch general practices. Neither the ‘test-and-treat’ policy recommended in the Maastricht guidelines, nor its advice regarding the choice of diagnostic tests (carbon urea breath test or serology), is being followed. The majority of GPs uses endoscopy for the detection of HP infection.

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Eradication of Helicobacter pylori in general practice

Abstract: The findings of this study indicate an urgent need for improved education if therapy for the eradication of H. pylori is to be used appropriately and safely.

Cited by 39 publications

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Regular review: Treatment of Helicobacter pylori infection

Regular review: Treatment of Helicobacter pylori infection

Gastric cancer and other endoscopic diagnoses in patients with benign dyspepsia

Dyspepsia Management in Primary Care in The Netherlands: To What Extent Is Helicobacter pylori Diagnosis and Treatment Incorporated?

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