Document Detail


Helicobacter treatment with quadruple therapy in primary health care for patients with a history of ulcer disease.
MedLine Citation:
PMID:  10533944     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Few patients with a history of peptic ulcer are treated by their GP for H. pylori infection, even though theoretical evidence supports such an approach. OBJECTIVES: We aimed to determine the validity of this recommendation and to test the feasibility of quadruple therapy in primary health care. METHODS: In this prospective, non-randomized intervention study, 51 unselected patients with a history of proven ulcer disease received a 7-day quadruple therapy (lansoprazole, colloidal bismuth subcitrate, tetracycline and metronidazole) from their GP. Main outcome measures were: (i) endoscopically confirmed cure of the infection; (ii) results of serology at entry and at 6 months follow-up; (iii) quality of life at entry, at 6 weeks and at 6 months follow-up; (iv) gastric symptoms at entry, at 6 weeks and at 6 months follow-up; and (v) medication at entry and at 6 months follow-up. RESULTS: Quadruple therapy was well tolerated and there were no drop-outs with this regimen. Intention to treat cure rate was 48/51 (94%, 95% CI 87-100%), per protocol cure rate was 48/49 (98%, 95% CI 94-100%). 45/50 (90%) had positive serology at entry. IgG antibody titres decreased > 40% in 95.2% of patients. Quality of life improved significantly after treatment, gastric symptoms decreased and medication use decreased. CONCLUSIONS: GPs should be encouraged to identify patients with a history of ulcer disease and chronic use of acid suppressants and offer them treatment for H. pylori infection. This approach will cure the infection in almost all patients, it will improve the quality of life and decrease costs. Quadruple therapy does not lose efficacy when employed in primary care. Pre-treatment serological testing is potentially useful for narrowing down the treatment group to those with actual infection, and serology is promising as an easy and cheap follow-up instrument in primary health care.
Authors:
J Y Lai; W J de Grauw; W A de Boer
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Family practice     Volume:  16     ISSN:  0263-2136     ISO Abbreviation:  Fam Pract     Publication Date:  1999 Oct 
Date Detail:
Created Date:  1999-12-07     Completed Date:  1999-12-07     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8500875     Medline TA:  Fam Pract     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  483-8     Citation Subset:  IM    
Affiliation:
Department of General Practice and Social Medicine, University of Nijmegen, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
2-Pyridinylmethylsulfinylbenzimidazoles
Adult
Aged
Anti-Bacterial Agents / therapeutic use*
Drug Therapy, Combination
Female
Helicobacter Infections / drug therapy*
Helicobacter pylori*
Humans
Intervention Studies
Male
Metronidazole / therapeutic use
Middle Aged
Omeprazole / analogs & derivatives,  therapeutic use
Organometallic Compounds / therapeutic use
Peptic Ulcer / microbiology*
Prospective Studies
Quality of Life
Questionnaires
Tetracycline / therapeutic use
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/2-Pyridinylmethylsulfinylbenzimidazoles; 0/Anti-Bacterial Agents; 0/Organometallic Compounds; 103577-45-3/lansoprazole; 443-48-1/Metronidazole; 57644-54-9/bismuth tripotassium dicitrate; 60-54-8/Tetracycline; 73590-58-6/Omeprazole

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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