| The role of screening for Helicobacter pylori in patients with duodenal ulceration in the primary health care setting. | |
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MedLine Citation:
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PMID: 8731626 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: It is known that at least 90% of duodenal ulcers are caused by infection with the bacterium Helicobacter pylori. Eradicating this organism usually results in complete resolution of the disease. Testing for H pylori was introduced relatively recently, and thus, many patients known to have uncomplicated peptic ulcer disease who continue to need long-term treatment with ulcer-healing drugs have never been tested for the infection or offered eradication therapy. In modern computerized practices, this subgroup of patients can readily be identified by reference to morbidity and repeat prescribing data. Eradication of H pylori infection in this group of patients has great potential benefit for the individuals concerned as well as cost-saving benefit for the National Health Service. AIM: The aim of this prospective study was to determine whether it is worthwhile screening for and treating H pylori infection in patients in a general practice population with previously diagnosed duodenal ulcer disease taking ulcer-healing drugs long term. METHOD: In 1994, in a practice of 7100 patients, morbidity and repeat prescribing data were used to identify 40 patients (0.6%) with proven duodenal ulcer disease taking ulcer-healing medication long term and with uncertain H pylori status. Twenty-nine of the 40 subjects agreed to undergo serology testing for H pylori antibodies. Of 20 (69%) who were positive, 18 (eight women, median age 63.8 years) were given eradication therapy. Seventeen patients received omeprazole 40 mg once daily and amoxycillin 500 mg three times daily for 14 days with metronidazole 400 mg three times daily for the first 7 days; for the remaining patient metronidazole was inadvertently omitted. [13C]Urea breath testing was carried out at the local hospital at least one month after therapy to determine whether eradication treatment had been successful. Subjects were also personally followed up by telephone after 1 and 4 months to assess the success of treatment subjectively. RESULTS: [13C]Urea breath testing showed that H pylori eradication was successful in all 17 patients (100%) who received the intended eradication regimen. Helicobacter pylori was not eradicated in the patient who received only omeprazole and amoxycillin. Four months after successful H pylori eradication, 13 of the 17 (76%) patients remained completely asymptomatic. Two of the four patients who had some recurrent dyspepsia had known gastro-oesophageal reflux and their ongoing symptoms after eradication therapy seemed, on close questioning, to be more attributable to this than to duodenal ulcer disease. CONCLUSION: Testing for and eradication of H pylori is worthwhile in general practice in those patients with previous proven duodenal ulceration who need long-term ulcer-healing medication. The high rate of eradication of H pylori achieved with the regimen used in this study compares very favourably with that of other treatment regimens. However, in patients with duodenal ulcers there may be coexisting pathology, and H pylori eradication does not necessarily result in complete disappearance of dyspeptic symptoms. Thus, when monitoring the outcome of treatment it is important to assess improvement of symptoms as well as objective evidence of eradication. |
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Authors:
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H Rosengren; R J Polson |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The British journal of general practice : the journal of the Royal College of General Practitioners Volume: 46 ISSN: 0960-1643 ISO Abbreviation: Br J Gen Pract Publication Date: 1996 Mar |
Date Detail:
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Created Date: 1996-10-11 Completed Date: 1996-10-11 Revised Date: 2009-11-18 |
Medline Journal Info:
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Nlm Unique ID: 9005323 Medline TA: Br J Gen Pract Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 177-9 Citation Subset: IM |
Affiliation:
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Solihull Hospital, West Midlands. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Amoxicillin / therapeutic use Anti-Ulcer Agents / therapeutic use Antibodies, Bacterial / blood Drug Therapy, Combination Duodenal Ulcer / drug therapy, microbiology* Female Helicobacter Infections / diagnosis*, drug therapy Helicobacter pylori* / immunology Humans Male Metronidazole / therapeutic use Middle Aged Omeprazole / therapeutic use Penicillins / therapeutic use Primary Health Care* Prospective Studies Serologic Tests |
| Chemical | |
Reg. No./Substance:
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0/Anti-Ulcer Agents; 0/Antibodies, Bacterial; 0/Penicillins; 26787-78-0/Amoxicillin; 443-48-1/Metronidazole; 73590-58-6/Omeprazole |
| Comments/Corrections | |
Comment In:
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Br J Gen Pract. 1996 Aug;46(409):491-2
[PMID:
8949333
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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