Optimizing testing and treatment for H. pylori in patients admitted with bleeding gastroduodenal ulcers: An interventional study

Abstract

Background: Despite the proven benefits of treating patients with bleeding gastric (GU) or duodenal ulcers (DU) who test positive for H. pylori (HP), many patients remain untested and/or untreated. Hypothesis: By the specific educational targeting of gastroenterologists regarding current HP treatment, rates of patient testing and therapy will increase. Methods: Patient care guidelines were actively disseminated to all gastroenterologists at our institution in July 1998. Rapid urease testing was advocated and a system established for recording results. Prompt initiation of HP therapy was recommended in patients with a positive result. Physicians who consistently deviated from these guidelines were contacted by the investigator or the nurse care manager (NCM). All patients admitted with endoscopically documented bleeding GU or DU were followed by the NCM. Patient data were prospectively collected at baseline (I st & 2nd qtr 1998) and post-intervention (3rd qtr'98 to 3rd qtr 1999). Treated patients were contacted by telephone at 2-months to ascertain treatment compliance. Likelihood ratio chi-square used for analysis. Results: See Table. NSAID use was similar between the 2 groups (mean 61%). Conclusion: H. pylori treatment can be markedly improved in patients admitted with bleeding gastroduodenal ulcers by the active promotion of inpatient care guidelines.