Eradication of Helicobacter pylori in general practice

To determine the current management of patients with Helicobacter pylori infection in general practice with regard to the selection of patients, testing for the presence of the organism, the choice of eradication therapy and the occurrence of symptoms during follow-up.

Cross-sectional survey involving the retrospective collection of data from patient medical records.

Five general practices in the Fife region of Scotland during June and July 1995.

The proportion of patients appropriately selected for eradication therapy and the success of treatment as assessed by remission of symptoms during follow-up.

Of 154 patients studied, 80% received eradication therapy for peptic ulcer disease, the remainder for non-ulcer dyspepsia or gastrooesophageal reflux. Fifty-six different regimens were used, the most common combination of drugs being omeprazole plus amoxycillin. H. pylori status was known in only one-third of patients before treatment and in only 15% after treatment. More than half of patients complained of recurrent symptoms of dyspepsia during follow-up after eradication therapy and 47% required further treatment. In terms of the selection of patients and testing for H. pylori, the overall management using eradication therapy was acceptable in less than half of patients. In particular, the management of patients with ulcer disease associated with either ulcerogenic drugs or previous complications failed to provide the essential protection against the high risk of future haemorrhage or perforation.

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.