Abstract
BackgroundPrimary 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.MethodsWe 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.ResultsNinety (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.ConclusionsWe 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.
Highlights
Primary care physicians (PCPs) play a pivotal role in the management of illnesses of the digestive tract
Helicobacter pylori (H. pylori) infection is the main cause of peptic ulcer disease and of gastric cancer [5]
In a large database analysis of Maccabi Health Services (MHS) we identified variations in the use of diagnostic tests of gastroesophageal reflux disease (GERD) compared to the guidelines [25]
Summary
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. Gastrointestinal complaints of the upper digestive tract such as abdominal pain, heartburn, nausea and vomiting are common in the primary care setting, while the differential diagnosis might vary from functional disorders to malignancy [1,2,3,4]. The diagnosis and management of gastroesophageal reflux disease (GERD) and peptic ulcer disease are of particular interest. According to the Maastricht V/Florence Consensus Report on the management of H. pylori infection, in young patients with uninvestigated dyspepsia the ‘testand-treat’ strategy with non-invasive test, usually urea breath test (UBT) is recommended. At least four weeks after completing therapy, a non-invasive test is recommended to confirm eradication of the infection [6]
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