Helicobacter pylori treatment instead of maintenance therapy for peptic ulcer disease: the effectiveness of case‐finding in general practice

Abstract

Background: Maintenance therapy with acid‐inhibiting medication is common in general practice. Since the eradication of Helicobacter pylori has become the treatment of choice for peptic ulcer disease, H. pylori treatment could replace maintenance therapy in patients with an ulcer history.Aim: To determine the effectiveness of a full peptic ulcer disease history case‐finding strategy, together with subsequent H. pylori testing and treatment, in discontinuing maintenance therapy.Method: Patients were included from seven general practices, who had been using acid‐inhibiting medication for more than 3 months in the period May 1996–May 1997. Patients with a history of proven peptic ulcer disease were tested, and treated with proton pump inhibitor‐triple therapy if positive. Maintenance therapy was discontinued and restart within 12 months was monitored.Results: Long‐term acid suppression was used by 2.8% of the practice‐populations. A peptic ulcer disease history was found in 18% of the patients, 73% of whom were offered the ‘H. pylori test and treat’ alternative. The majority responded: 92% of the H. pylori‐infected patients were treated, 78% of whom successfully discontinued long‐term medication.Conclusion: Implementing an ‘H. pylori test and treat’ strategy enabled one‐third of the patients with a peptic ulcer disease history to stop maintenance therapy successfully. The strategy contributes to reduction of long‐term drug use, but compliance needs improvement.

Search and treat strategy to eliminate Helicobacter pylori associated ulcer disease

“…Prach et al found that in a cohort of 145 patients receiving long term H 2 receptor antagonists for chronic duodenal ulcer disease only 11.7% were Helicobacter negative,34 a value close to the 10% we found in our study35 and the 13% in another Dutch study 36. Cost effectiveness and decision analyses also suggest that physicians can give antibiotics to patients with an ulcer history without a prior diagnostic test 37…”

“…40-44 UK studies showed that about one third of patients that regularly use acid suppressants had proven ulcer disease 40-42. A study performed in the Amsterdam area found a rate of 39.2%,43 whereas a study in central Holland found a lower rate of 18%,36 similar to that found in the south (20%) 45. Furthermore, many patients use these drugs without a formal diagnosis (endoscopy or barium meal)34 38-43 and a significant percentage of such chronic and uninvestigated patients will probably also suffer from recurrent ulcers.…”

“…In the Netherlands, de Wit et al found that 2.8% of patients from 13 general practitioners were using acid suppressants long term36 and they searched their medical records. Thirty five per cent had never been investigated but 18% had documented proof of ulcer disease.…”

Helicobacter pylori Eradication in Patients on Long‐ Term H2 Receptor Antagonists. Economic and Symptomatic Benefits. A Large Prospective Study in Primary Care

“…Even though a large proportion of patients in primary care is on long‐term acid suppression, to our knowledge no large study has addressed the prevalence of H. pylori in this subgroup of patients nor assessed the merits of eradication H. pylori in those who are positive. A number of small studies that did attempt to answer these questions gave encouraging results, but they concentrated only on symptomatic benefit and included only patients with peptic ulcer dyspepsia (PUD) [14–17]. We therefore designed this large study to assess the prevalence of H. pylori and the symptomatic and economic benefits of eradicating this organism in patients on long‐term H 2 RA in six primary care practices in the north of England (Humberside region).…”

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

“…It may be explained by the hesitation that many GPs feel to change treatment in patients who are doing well on chronic acid suppression. More effort needs to be put in education about the benefit of HP eradication as a cost-effective alternative to acid suppression in these patients [24]. …”