Dataset Information

Physicians' adherence to management guidelines for H. pylori infection and gastroesophageal reflux disease: a cross-sectional study.

ABSTRACT:

Background

Primary care physicians (PCPs) play a pivotal role in the management of illnesses of the digestive tract. The study aim was to assess the adherence of PCPs to the guidelines on the management of Helicobacter pylori (H. pylori) infection and gastroesophageal reflux disease (GERD) in adults.

Methods

We conducted a cross-sectional study during March-July 2017 using the survey platform of Maccabi Healthcare Services in Israel. The study questionnaire assessed adherence to the Maastricht/Florence guidelines on H. pylori infection and the American College of Gastroenterology guidelines on the management of GERD. We sent the study questionnaires to a random sample of 610 PCPs via electronic mails. We contacted those who did not respond by telephone; eventually 180 physicians completed the survey.

Results

Ninety (50%) and 60 (36%) of the responders reported using professional guidelines for the diagnosis and management of H. pylori infection and GERD, respectively. Of the 180 participants, 153 (85%) reported referring patients with suspected peptic ulcer disease to H. pylori testing, 109 (61%) reported referring patients with unexplained iron deficiency anemia and 83 (46%) refer relatives of gastric cancer patients. In caring for young patients who have dyspepsia without alarm symptoms, 127 (74%) reported referral to a urea breath test for the diagnosis of H. pylori infection, and 136 (81%) referral to a specialist in gastroenterology if alarm symptoms present. Triple therapy with proton pump inhibitors/clarithromycin/amoxicillin or metronidazole was reported as first-line therapy by 141 (83%) participants. For GERD, 94-98% of the participants followed the appropriate recommendations.

Conclusions

We identified gaps between the practices of PCPs and the guidelines on H. pylori infection management, while guidelines on GERD management are well adopted. Simplification of the guidelines and exploring barriers towards their implementation by PCPs is warranted.

SUBMITTER: Na'amnih W

PROVIDER: S-EPMC7291643 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Publications

Physicians' adherence to management guidelines for H. pylori infection and gastroesophageal reflux disease: a cross-sectional study.

Na'amnih Wasef W Ben Tov Amir A Bdair-Amsha Amna A Cohen Shlomi S Tsamir Judith J Chodick Gabriel G Muhsen Khitam K

Israel journal of health policy research 20200611 1

<h4>Background</h4>Primary care physicians (PCPs) play a pivotal role in the management of illnesses of the digestive tract. The study aim was to assess the adherence of PCPs to the guidelines on the management of Helicobacter pylori (H. pylori) infection and gastroesophageal reflux disease (GERD) in adults.<h4>Methods</h4>We conducted a cross-sectional study during March-July 2017 using the survey platform of Maccabi Healthcare Services in Israel. The study questionnaire assessed adherence to t ...[more]

PMID: 32527326

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Project description:ObjectivesThe role of Helicobacter pylori (H pylori) in gastroesophageal reflux disease (GERD) remains controversial, particularly in children, because there are limited published data. Adult studies suggested that H pylori infection may protect against GERD by causing atrophic gastritis, which leads to reduced gastric acid secretion. The objective of our study was to determine the role of H pylori infection in the development of GERD in a pediatric population.Patients and methodsA retrospective analysis of 420 patients (M:F = 214:206) who underwent esophagogastroduodenoscopy (EGD) with biopsies between January 2000 and April 2006 was conducted. Patient demographics, clinical indications for EGD and the prevalence of reflux esophagitis (RE), the biomarker for GERD, in 2 groups, H pylori positive and H pylori negative, were reviewed. The prevalence of RE in the H pylori-positive and H pylori-negative groups was further analyzed on the basis of sex and age (<1 year, 1-10 years, >10 years). The mean age of the study population was 8.2 years (range 0-20 years). The clinical indications for EGD were as follows: recurrent abdominal pain (n = 186, 44%), malabsorption (n = 80, 19%), persistent vomiting (n = 80, 19%), suspected eosinophilic gastrointestinal disorders (n = 63, 15%), and others such as upper gastrointestinal bleeding or inflammatory bowel disease surveillance (n = 11, 3%). Statistical analysis was performed by using chi test, Fisher exact test, and multivariate logistical regression analysis.ResultsAmong the 420 patients, 16 patients (3.8%) were positive for H pylori and 167 patients (39.8%) were found to have RE. Thirteen patients with H pylori were found to have histologic evidence of RE. The prevalence of RE in the H pylori-positive population was 81.3% compared with 38.1% in the H pylori-negative population (P < or = 0.05). There were no patients with H pylori in the youngest age group. In the second age group (1-10 years), 100% of the H pylori-positive patients had RE, whereas 44.6% of the H pylori-negative patients had RE (P < or = 0.05). Both male and female patients with H pylori had a higher prevalence of RE, 77.8% and 85.7%, respectively. On a multivariate logistical regression, for the overall study cohort, H pylori-positive patients had an odds ratio of 5.79 of developing RE compared with H pylori-negative patients (P < or = 0.05).ConclusionsOur study results indicate that there is a significantly higher prevalence of RE in an H pylori-infected cohort independent of age or sex. The findings suggest that H pylori infection in children is positively associated with RE.

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Project description:BACKGROUND: Gastroesophageal reflux disease (GERD) is a very common disorder worldwide, comprised of reflux esophagitis (RE) and non-erosive reflux disease (NERD). As more than half of GERD patients are classified into the NERD group, precise evaluation of bothersome epigastric symptoms is essential. Nevertheless, compared with many reports targeting endoscopic reflux esophagitis, large-scale studies focusing on GERD symptoms have been very scarce. METHODS: To elucidate lifestyle factors affecting GERD symptoms, 19,864 healthy adults in Japan were analyzed. Sub-analyses of 371 proton pump inhibitor (PPI) users and 539 histamine H?-receptor antagonist (H?RA) users were also performed. Using the FSSG (Frequency Scale for the Symptoms of GERD) score as a response variable, 25 lifestyle-related factors were univariately evaluated by Student's t-test or Pearson's correlation coefficient, and were further analyzed with multiple linear regression modelling. RESULTS: Average FSSG scores were 4.8 ± 5.2 for total subjects, 9.0 ± 7.3 for PPI users, and 8.2 ± 6.6 for H?RA users. Among the total population, positively correlated factors and standardized coefficients (?) for FSSG scores are inadequate sleep (? = 0.158), digestive drug users (? = 0.0972 for PPI, ? = 0.0903 for H?RA, and ? = 0.104 for others), increased body weight in adulthood (? = 0.081), dinner just before bedtime (? = 0.061), the habit of midnight snack (? = 0.055), lower body mass index (? = 0.054), NSAID users (? = 0.051), female gender (? = 0.048), lack of breakfast (? = 0.045), lack of physical exercise (? = 0.035), younger age (? = 0.033), antihyperglycemic agents non-users (? = 0.026), the habit of quick eating (? = 0.025), alcohol drinking (? = 0.025), history of gastrectomy (? = 0.024), history of cardiovascular disease (? = 0.020), and smoking (? = 0.018). Positively correlated factors for PPI users are female gender (? = 0.198), inadequate sleep (? = 0.150), lack of breakfast (? = 0.146), antihypertensive agent non-users (? = 0.134), and dinner just before bedtime (? = 0.129), whereas those for H?RA users are inadequate sleep (? = 0.248), habit of midnight snack (? = 0.160), anticoagulants non-users (? = 0.106), and antihypertensive agents non-users (? = 0.095). CONCLUSIONS: Among many lifestyle-related factors correlated with GERD symptoms, poor quality of sleep and irregular dietary habits are strong risk factors for high FSSG scores. At present, usual dose of PPI or H?RA in Japan cannot fully relieve GERD symptoms.

Dataset Information

Physicians' adherence to management guidelines for H. pylori infection and gastroesophageal reflux disease: a cross-sectional study.

Background

Methods

Results

Conclusions

Publications

Physicians' adherence to management guidelines for H. pylori infection and gastroesophageal reflux disease: a cross-sectional study.

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