Issues of concern in the diagnosis, treatment and eradication control for the Helicobacter pylori infection at the stage of primary healthcare (based on the results of questioning of primary care physicians)

Abstract

Objective — based on the results of questioning of primary care physicians, to investigate the status of their awareness regarding the diagnosis, treatment and eradication control for the Helicobacter pylori infection in patients with gastrointestinal pathology.Materials and methods. The questioning involved 359 primary care physicians from the primary healthcare centers and family out-patients clinics in five regions. In Vinnytsya region, 113 physicians were inquired, in Khmelnytsky region 85 subjects, in Zhytomyr region 80 doctors, in Cherkasy region 38, and in Chernyhiv region 43 primary care physicians. The questionnaire included questions related to the H. pylori diagnosis methods, schemes of H. pylori eradication and methods of control for the efficacy of the conducted treatment, used by the physicians in their clinical practice.Results. From 359 respondents, 337 (93.9 %) had modern understanding of the etiological role of H. pylori, 22 (6.1 %) were doubting in the H. pylori significance in the pathology of the upper departments of gastrointestinal tract. From all respondents, only 192 (53.5 %) doctors preferred non-invasive H. pylori infection diagnosis (determination of IgG antibodies to H. pylori), breath urease tests, determination of H. pylori antigen in feces), and 147 physicians (40.9 %) used predominantly invasive tests for H. pylori diagnosis (upper endoscopy with bacterioscopic biopsy examination and upper endoscopy with resulting biopsy with express urease test). As for the choice of the proton pump inhibitor in the scheme of H. pylori eradication, 137 primary care physicians (38.2 %) preferred pantoprazole, 109 (30.4 %) omeprazole, 79 (22 %) rabeprazole, 25 (6.9 %) esomeprazole, and 9 more (2.5 %) outlined that did not see a difference between PPIs in the H. pylori eradication efficacy. The 1st line schemes of H. pylori eradication in compliance with the requirements of the international and national consensus, were administered by 73.2 % of the primary care physicians. As a control method for the H. pylori eradication, 125 (34.8 %) of physicians preferred the determination of IgG antibodies to H. pylori, 66 (18.4 %) — upper endoscopy with bacterioscopic biopsy examination, 18 (5.0 %) — upper endoscopy with resulting biopsy with express urease test, 82 (22.8 %) — breath urease tests, 57 (15.9 %) — determination of H. pylori antigen in feces.Conclusions. The primary care physicians in the central and northern regions of Ukraine underused the non-invasive methods for the H. pylori infection diagnosis. For the 1st line schemes of anti-helicobacter therapy, they used evidence-based treatment schemes. The trend has been revealed to the relative non-compliance with the recommendations of Maastricht V regarding the general duration of eradication therapy. To control the efficacy of the H. pylori eradication, the primary care physicians underused the modern non-invasive methods.