© 1998 Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom
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How might general practitioner knowledge of patient Helicobacter pylori status change the management of dyspepsia in primary care?
J. M. Parry, Lecturer in Public Health and Epidemiology
R. C. Foy, Senior Registrar in Public Health Medicine
C. B. J. Woodman, Professor of Public Health and Epidemiology
Centre for Cancer Epidemiology Kinnaird Road, Withington, Manchester M20 6QL
Stockport Health Authority Springwood House, Poplar Grove, Hazel Grove, Stockport SK7 5BY
Centre for Cancer Epidemiology Kinnaird Road, Withington, Manchester M20 6QL
Address correspondence to Dr J. M. Parry
BACKGROUND: Recent guidelines have suggested that testing young dyspeptic patients for Helicobacter pylori infection will produce more appropriate referrals for endoscopic investigation. Our aim was to describe how awareness of patient H. pylori status changes the practice of general practitioners (GPs) who do not currently use H. pylori testing and/or eradication in their management of dyspepsia. We studied a 5 per cent systematic sample (n = 177), stratified by health authority, of GPs in the North West region of England.
METHODS: A questionnaire-based assessment of self-reported practice of young patients with dyspepsia was carried out.
RESULTS: Over three-quarters of GPs would choose eradication therapy rather than ulcer healing drugs if they knew the patient was positive for H. pylori infection. Twenty-nine per cent of GPs would refer for endoscopy when the patient's H. pylori status was unknown, 32 per cent when it was positive, and 22 per cent when it was negative. However, GPs responded in an inconsistent manner to knowledge of patient H. pylori status. Some chose to refer positive patients only, others only patients with negative status, and a minority would refer both positive and negative patients.
CONCLUSIONS: Until the use of H. pylori tests in primary care populations has been evaluated in appropriate prospective randomized controlled trials, advocates of testing as a means to reduce endoscopy referrals should be cautious about its potential impact on service workload.
Keywords: Helicobacter pylori, primary care, dyspepsia, endoscopy
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  J G Williams, S E Roberts, M F Ali, W Y Cheung, D R Cohen, G Demery, A Edwards, M Greer, M D Hellier, H A Hutchings, et al. Gastroenterology services in the UK. The burden of disease, and the organisation and delivery of services for gastrointestinal and liver disorders: a review of the evidence Gut, February 1, 2007; 56(suppl_1): 1 - 113. [Full Text] [PDF]
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