1
|
Predictors of long-term outcome of functional dyspepsia and duodenal ulcer after successful Helicobacter pylori eradication--a 7-year follow-up study. Eur J Gastroenterol Hepatol 2009; 21:387-93. [PMID: 19182682 DOI: 10.1097/meg.0b013e3283069db0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIMS To investigate the course of dyspeptic symptoms, predictors of symptom relief and use of antidyspeptic drugs in patients with duodenal ulcer disease and functional dyspepsia 6-7 years after successful Helicobacter pylori eradication. PATIENTS AND METHODS Patients with H. pylori-positive duodenal ulcer or functional dyspepsia, included in a prospective, randomized study from January 1996 to June 1997, and successfully treated with standard triple therapy, were eligible. After 6-7 years, case histories of 142 patients were retrieved and patients were interviewed by telephone. They were asked about the presence of dyspeptic symptoms and health care needs during the last week and over the last 6-7 years. Predictive factors of complete long-term relief of symptoms have been evaluated. RESULTS Of the 114 eligible patients, 104 (49 with duodenal ulcer and 55 with functional dyspepsia) were included in the study. The mean duration of follow up was 6.6+/-0.5 years. Complete relief of dyspeptic symptoms was reported, in this period, by 49.0% of duodenal ulcer patients and 36.4% of patients with functional dyspepsia (P=0.271). Persistence of symptoms within 3 months of H. pylori eradication and female sex were predictive of persistence of symptoms in the following 6-7 years, in patients with functional dyspepsia. In turn, approximately 50% of the patients with complete symptom remission, within 6 months of H. pylori eradication, later became symptomatic. Since the end of the H. pylori eradication trial, 26.9% of patients were still using or had used antidyspeptic drugs; patients with functional dyspepsia having used them more frequently than duodenal ulcer patients (36.4 vs. 16.3%; P=0.037). CONCLUSION In clinical practice, long-term symptomatic benefit, in duodenal ulcer patients, after H. pylori eradication, is similar to that in patients with functional dyspepsia. Early evaluation of symptoms after successful H. pylori eradication may be predictive of outcome in dyspeptic patients. Most symptomatic patients did not seek antidyspeptic drugs. Use of antisecretory medications was, however, greater in patients with functional dyspepsia than in duodenal ulcer patients.
Collapse
|
2
|
Jarbol DE, Bech M, Kragstrup J, Havelund T, Schaffalitzky de Muckadell OB. Economic evaluation of empirical antisecretory therapy versus Helicobacter pylori test for management of dyspepsia: a randomized trial in primary care. Int J Technol Assess Health Care 2006; 22:362-71. [PMID: 16984065 DOI: 10.1017/s0266462306051269] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES An economic evaluation was performed of empirical antisecretory therapy versus test for Helicobacter pylori in the management of dyspepsia patients presenting in primary care. METHODS A randomized trial in 106 general practices in the County of Funen, Denmark, was designed to include prospective collection of clinical outcome measures and resource utilization data. Dyspepsia patients (n = 722) presenting in general practice with more than 2 weeks of epigastric pain or discomfort were managed according to one of three initial management strategies: (i) empirical antisecretory therapy, (ii) testing for Helicobacter pylori, or (iii) empirical antisecretory therapy, followed by Helicobacter pylori testing if symptoms improved. Cost-effectiveness and incremental cost-effectiveness ratios of the strategies were determined. RESULTS The mean proportion of days without dyspeptic symptoms during the 1-year follow-up was 0.59 in the group treated with empirical antisecretory therapy, 0.57 in the H. pylori test-and-eradicate group, and 0.53 in the combination group. After 1 year, 23 percent, 26 percent, and 22 percent, respectively, were symptom-free. Applying the proportion of days without dyspeptic symptoms, the cost-effectiveness for empirical treatment, H. pylori test and the combination were 12,131 Danish kroner (DKK), 9,576 DKK, and 7,301 DKK, respectively. The incremental cost-effectiveness going from the combination strategy to empirical antisecretory treatment or H. pylori test alone was 54,783 DKK and 39,700 DKK per additional proportion of days without dyspeptic symptoms. CONCLUSIONS Empirical antisecretory therapy confers a small insignificant benefit but costs more than strategies based on test for H. pylori and is probably not a cost-effective strategy for the management of dyspepsia in primary care.
Collapse
Affiliation(s)
- Dorte Ejg Jarbol
- The Research Unit for General Practice, University of Southern Denmark, Odense.
| | | | | | | | | |
Collapse
|
3
|
Krag A, Teglbjerg LS, Malchow-Møller A, Hallas J, Bytzer P. Prescribing of acid suppressive therapy: interactions between hospital and primary care. Aliment Pharmacol Ther 2006; 23:1713-8. [PMID: 16817914 DOI: 10.1111/j.1365-2036.2006.02950.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Overuse of acid suppressive therapy in the hospital setting and in primary care is well documented. AIM To describe interactions between prescriptions of acid suppressive therapy in hospital and in primary care. METHODS All patients admitted to hospital over a 24-month period were identified. Details about prescription of acid suppressive therapy were retrieved. All prescriptions of acid suppressive therapy redeemed by these patients 12 months before and after discharge were retrieved from a prescription database. RESULTS A total of 549 of 4477 patients (12.3%) were treated with acid suppressive therapy while in hospital, but acid suppressive therapy was prescribed de novo in only 192 (35%) of these cases. Information about indication for acid suppressive therapy and planned duration of therapy were given in the discharge letter in only 25% and 17% of the cases, respectively. Among patients treated with acid suppressive therapy during admission, prescriptions on acid suppressive therapy were redeemed by 67% in the year before admission and by 74% in the year after discharge. Among patients who had the acid suppressive therapy discontinued during admission (n = 67), 48% resumed acid suppressive therapy within the following 12 months. Of all subjects treated with acid suppressive therapy in the hospital catchment area, 7.8% were seen in our department. CONCLUSIONS Decisions about acid suppressive therapy prescribing in hospital has little influence on prescribing in primary care.
Collapse
Affiliation(s)
- A Krag
- Department of Medicine, Svendborg Hospital, Svendborg, Denmark
| | | | | | | | | |
Collapse
|
4
|
Segarra-Newnham M. Treating Veterans for Helicobacter Pylori Infection: Retrospective Evaluation of Long-term Outcomes. Hosp Pharm 2004. [DOI: 10.1177/001857870403901206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Purpose This study documented the long-term outcomes of patients treated in a pharmacist-managed Helicobacter pylori (HP) clinic. Background An HP clinic was created in 1996 at a Veterans Affairs (VA) hospital. Patients received clarithromycin/amoxicillin-based therapy according to the clinic protocol. Clarithromycin use was restricted to treatment of HP infection. Metronidazole was used instead of amoxicillin in penicillin allergic patients. Results at 1 year showed that 53% of the patients were able to discontinue chronic heartburn therapy. Outcomes beyond 1 year were not established. Methods The electronic records of patients treated at the HP clinic from June 1996 to March 2001 were evaluated. Patients with at least 2 years of follow-up information were included. Baseline demographic and long-term outcome data were collected. Discontinuation rate, failure rate, and need for retreatment were evaluated. Results Of 229 patients treated during the period studied, at least 2 years of data was available for 198 individuals. Of these, 177 were men and 21 were women. Three of the 198 patients (1.5%) were unable to complete antibiotic therapy. Five patients (2.5%), two of them women, failed an initial course to eradicate HP. After treatment with bismuth-based therapy, four of these five patients showed documented eradication of infection. Forty-four percent of patients were off chronic therapy at the time of last review. Conclusions A pharmacist-managed HP treatment clinic can facilitate discontinuation of chronic acid suppressive therapy in more than a third of patients. A low treatment failure rate — below the national average for clarithromycin-based regimens — was found in our population.
Collapse
|
5
|
Majumdar SR, Soumerai SB, Farraye FA, Lee M, Kemp JA, Henning JM, Schrammel P, LeCates RF, Ross-Degnan D. Chronic acid-related disorders are common and underinvestigated. Am J Gastroenterol 2003; 98:2409-14. [PMID: 14638341 DOI: 10.1111/j.1572-0241.2003.07706.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aims of this study were as follows: to establish the prevalence of chronic acid-related disorders in a managed care population; to describe these patients; and to examine rates of adherence to current guidelines for investigation of dyspepsia and peptic ulcer disease. METHODS The design was a population-based cohort study. The sample was drawn from 216,720 adult (aged >18 yr) members of a managed care organization that had an electronic medical record linked to administrative and pharmacy databases. We included adults with continuous enrollment from July, 1998, to January, 2000, who were dispensed histamine-2 blockers or proton-pump inhibitors, or both, for > or =1 yr. Dispensing data, sociodemographic and clinical information, comorbidities, and investigations were collected and analyzed. RESULTS The final cohort consisted of 5064 patients; 64% were aged > or =50 yr, 47% were male, and 11% were African American. The prevalence of chronic acid-related disorders was 2.3%. Gastroesophageal reflux disease (59%) was the most common condition, followed by dyspepsia (35% of cohort; 18% investigated by endoscopy). There were 917 dyspepsia patients > or =50 yr who had not been investigated by endoscopy (81% of dyspepsia patients in this age group). There were 97 patients with peptic ulcer disease who did not have a documented test for Helicobacter pylori (34% of patients with peptic ulcer disease). CONCLUSIONS Chronic acid-related disorders are common in primary care, and many patients use acid suppressing medications on a long-term basis. Nevertheless, according to current practice guidelines, our patients were underinvestigated. Future guidelines should specifically address the management of patients who use acid suppressing medications on a chronic basis.
Collapse
Affiliation(s)
- Sumit R Majumdar
- Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts 02215, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Kearney DJ, Liu CF, Crump C, Brousal A. The effect of a Helicobacter pylori treatment strategy on health care expenditures in patients with peptic ulcer disease and dyspepsia. Am J Gastroenterol 2003; 98:1952-62. [PMID: 14499771 DOI: 10.1111/j.1572-0241.2003.07584.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether treatment for Helicobacter pylori (H. pylori) for patients with dyspepsia or a history of peptic ulcer decreases hospital expenditures. METHODS Patients receiving acid suppressive medications were interviewed. Those with a documented ulcer, a self-reported ulcer, or dyspepsia were tested for H. pylori and treated with antibiotics if seropositive. Acid suppressive medications were stopped on completion of H. pylori therapy unless there was a history of gastroesophageal reflux disease (GERD) or Barrett's esophagus, and were started again at the discretion of primary care providers. Total hospital costs and GI medication costs in the 12 months before H. pylori treatment were compared to costs 12 months after H. pylori treatment. RESULTS A total of 432 consecutive patients were treated for H. pylori. Of the patients, 125 (29%) had dyspepsia, 45 (10%) documented peptic ulcer, and 262 (61%) self-reported peptic ulcer. Total costs (mean 327 US dollars +/- 349 vs 291 USA dollars +/- 362, p = 0.06) and medication costs (mean 207 US dollars +/- 237 vs 224 US dollars +/- 277, p = 0.38) were not significantly different after treatment versus before treatment. A significant decrease in expenditures was limited to patients chronically on acid suppressive medications who had documented peptic ulcers and no history of GERD or Barrett's esophagus (mean 482 US dollars +/- 274 vs 282 US dollars +/- 218, p = 0.03). CONCLUSIONS Treatment of H. pylori for patients with chronic dyspepsia or self-reported peptic ulcer does not reduce expenditures over 1 yr of follow up. H. pylori treatment for patients chronically receiving acid suppressive treatment with a prior documented ulcer significantly reduces expenditures if GERD and Barrett's esophagus are absent.
Collapse
Affiliation(s)
- David J Kearney
- Primary and Specialty Medical Care Service, VA Puget Sound Health Care System, Seattle, Washington, USA
| | | | | | | |
Collapse
|
7
|
Makris N, Crott R, Fallone CA, Bardou M, Barkun A. Cost-effectiveness of routine endoscopic biopsies for Helicobacter pylori detection in patients with non-ulcer dyspepsia. Gastrointest Endosc 2003; 58:14-22. [PMID: 12838214 DOI: 10.1067/mge.2003.295] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The role of endoscopic biopsies in the detection of Helicobacter pylori in patients with nonulcer dyspepsia is poorly defined. This study assesses the cost-effectiveness of performing routine biopsies for the detection of H pylori at upper endoscopy in these patients. METHODS Clinical decision-making was modeled based on outcomes data from published articles and expert opinion. The target group was adults, less than 45 years of age, with nonulcer dyspepsia as defined by a normal endoscopy. Costs, expressed in Canadian dollars, were tabulated over a 1-year time horizon. The main outcome was relief of symptoms, defined as the absence of symptom persistence or recurrence over the 12 months. A strategy of performing a biopsy for the detection of H pylori with a rapid urease test during gastroscopy was compared with that of not performing a biopsy. In addition, as a secondary analysis, the cost-effectiveness of obtaining a biopsy specimen for histopathologic evaluation in patients after a negative rapid urease test was evaluated. RESULTS A strategy of endoscopy with biopsy and rapid urease testing costs 3940 dollars per additional symptom-free patient as compared with endoscopy without biopsy. This result was sensitive to the difference in symptomatic recurrence rate at 1 year between patients in whom H pylori was successfully and unsuccessfully eradicated, which in this analysis, was set at 9.9%. Only when the difference in symptomatic recurrence in patients with successful versus unsuccessful eradication fell to less than 4% was endoscopy with biopsy over 10,000 dollars per cured patient greater than endoscopy without biopsy. The conclusions were otherwise robust when varying the values of other variables across clinically relevant ranges. There was little additional benefit associated with histopathologic assessment of biopsy specimens in patients with a negative rapid urease test and the cost per additional cure was 25,529 dollars. CONCLUSIONS In adults with nonulcer dyspepsia under age 45 years undergoing endoscopy, routine procurement of a biopsy specimen for detection of H pylori was more costly yet more effective compared with not obtaining a specimen. The cost-effectiveness of a biopsy is dependent on the benefits of H pylori eradication in this patient population. The less likely a patient with nonulcer dyspepsia is to become asymptomatic after successful H pylori eradication, the more costly a strategy of routinely obtaining a specimen at endoscopy. The additional cost of sending a specimen for histopathologic analysis if the rapid urease test is negative does not appear warranted based on cost-effectiveness considerations.
Collapse
Affiliation(s)
- Nicholaos Makris
- Division of Gastroenterology, McGill University Health Center and Department of Clinical Epidemiology, McGill University, Montréal, Québec, Canada
| | | | | | | | | |
Collapse
|
8
|
Rosandić M, Pilas V, Bevanda M, Falisevac V, Korać B. Quantification of Helicobacter pylori resistance in functional and organic dyspepsia. J Clin Pharm Ther 2002; 27:353-5. [PMID: 12383136 DOI: 10.1046/j.1365-2710.2002.00428.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare the efficacy of Helicobacter pylori eradication in patients with functional and organic dyspepsia. METHODS The study included a cohort of 160 patients (115 with organic and 45 with functional dyspepsia) with dyspeptic symptoms and gastroscopically confirmed H. pylori infection. Triple therapy with omeprazole 20 mg, amoxicillin 1000 mg and metronidazole 400 mg (OAM) was administered twice a day for a week. Minimal inhibition concentration (MIC) was estimated on cultures from 41 patients with positive H. pylori for determination of antimicrobial sensitivity and primary resistance to amoxicillin and metronidazole. RESULTS Endoscopic examination at least 6 weeks after therapy showed that 116 (72.5%) patients had H. pylori eradicated, whereas 44 (27.5%) were not. From the latter patients, 10 (23%) had functional dyspepsia and from 116 eradicated patients 35 (30%) had functional dyspepsia. Difference in efficacy of OAM therapy between patients with organic and functional dyspepsia was not significant (P > 0.5). Percentages of non-eradicated patients with organic and functional dyspepsia were 29.6 and 22.2%, respectively (ratio 1.3 : 1). MIC from 41 samples showed 18 (44%) in vitro resistant strains. There was no resistance to amoxicillin. CONCLUSIONS There is no significant difference in H. pylori resistance to the same antibiotic between patients having functional or organic dyspepsia.
Collapse
Affiliation(s)
- M Rosandić
- Division of Gastroenterology, Department of Internal Medicine, University Hospital Rebro, University of Zagreb, Croatia.
| | | | | | | | | |
Collapse
|
9
|
Spiegel BMR, Vakil NB, Ofman JJ. Dyspepsia management in primary care: a decision analysis of competing strategies. Gastroenterology 2002; 122:1270-85. [PMID: 11984514 DOI: 10.1053/gast.2002.33019] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Brennan M R Spiegel
- Department of Medicine and Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | |
Collapse
|
10
|
Gisbert JP, Calvet X, Gabriel R, Pajares JM. [Helicobacter pylori infection and functional dyspepsia. Meta-analysis of efficacy of eradication therapy]. Med Clin (Barc) 2002; 118:405-9. [PMID: 11943102 DOI: 10.1016/s0025-7753(02)72403-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND To establish a causal link between Helicobacter pylori infection and functional dyspepsia it is necessary to demonstrate that H. pylori eradication induces an improvement in dyspeptic symptoms. Our aim was to perform a meta-analysis of randomized studies comparing, in functional dyspepsia, the efficacy of H. pylori eradication treatment with that of treatments with no effect on H. pylori infection. PATIENTS AND METHODS DATA SOURCES PubMed database, Cochrane Controlled Trials Register, and abstracts from congresses until 2001. SELECTION CRITERIA a) studies including patients with functional dyspepsia and H. pylori infection; b) randomized trials comparing H. pylori eradication treatment with treatment (control) with no effect on H. pylori infection, and c) follow-up of at least 6 months. The quality of studies was assessed by a validated score. STATISTICS the main outcome was the percentage of patients improving in each therapeutic group. A meta-analysis was performed combining the odds ratios (OR) of individual studies in a global OR. RESULTS Nine studies fulfilled the inclusion criteria and were thus included in the meta-analysis. Overall, 953 patients received an eradication treatment and 958 received a control treatment. The overall percentage of patients with symptomatic improvement in the eradication group was 43% (95% CI, 40-46%), and it was 39% (95% CI, 36-42%) in the control group. The OR for the effect of the eradication treatment vs. the control treatment was 1.20 (95% CI, 0.91-1.58). The number needed to treat (NNT) with eradication therapy to achieve a symptomatic improvement, compared with the control group, was 25. Although heterogeneity was demonstrated, it disappeared when one study showing positive, clearly discordant results was excluded. Thus, the percentage of patients with symptomatic improvement in the eradication treatment group was 47% (95% CI, 43-50%) and it was 45% (95% CI, 41-48%) in the control group (OR: 1.06; 0.85-1.31; NNT: 50). CONCLUSIONS H. pylori eradication treatment is not associated with a statistically significant improvement of symptoms in patients with functional dyspepsia.
Collapse
Affiliation(s)
- Javier P Gisbert
- Servicio de Aparato Digestivo. Hospital Universitario de la Princesa. Madrid. Spain.
| | | | | | | |
Collapse
|
11
|
Hurenkamp GJ, Grundmeijer HG, Van Der Ende A, Tytgat GN, Assendelft WJ, Van Der Hulst RW. Arrest of chronic acid suppressant drug use after successful Helicobacter pylori eradication in patients with peptic ulcer disease: a six-month follow-up study. Aliment Pharmacol Ther 2001; 15:1047-54. [PMID: 11421881 DOI: 10.1046/j.1365-2036.2001.01017.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND It remains controversial whether successful H. pylori eradication leads to relief of dyspepsia and the subsequent arrest or tapering of acid-suppressant drug therapy, or to an aggravation of acid-related dyspepsia requiring more acid-suppressant drug intake. AIM To evaluate prospectively the effect of H. pylori eradication on the requirement of acid-suppressant drug or antacids and the evolution of dyspeptic symptoms in chronic acid-suppressant drug users with peptic ulcer disease. MATERIALS AND METHODS The use of acid-suppressant drugs, rescue antacids and predominant symptoms were recorded prospectively during 24 weeks after H. pylori eradication therapy in 75 peptic ulcer disease patients. RESULTS In 71 patients with complete follow-up, ulcers were healed at follow-up endoscopy and H. pylori was successfully eradicated. After 6 months, 93% (66 out of 71) of chronic acid-suppressant drug users had stopped acid-suppressant drug intake. The mean daily acid-suppressant drug dosage per patient decreased from 1.72 at entry to 0.03 units acid-suppressant drug (98%; P < 0.0001) during follow-up. The mean number of antacid tablets/day/patient was 0.26 during follow-up for the relief of mild inter-current dyspeptic symptoms. Medication use was not different in peptic ulcer disease patients with or without gastro-oesophageal reflux disease at baseline. The prevalence of gastro-oesophageal reflux disease decreased from 42% before to 35% after H. pylori eradication (N.S.). CONCLUSION Successful H. pylori eradication in peptic ulcer disease patients almost completely eliminates the need for acid-suppressant drug regardless of the presence or absence of gastro-oesophageal reflux disease at entry.
Collapse
Affiliation(s)
- G J Hurenkamp
- Department of General Practice, Academic Medical Centre, Meibergdreef 9, Amsterdam, the Netherlands.
| | | | | | | | | | | |
Collapse
|
12
|
O'Connor HJ, Stewart C, Walsh R, McGee CN, Flynn B. Six-year follow-up after Helicobacter pylori eradication in peptic ulcer disease. Ir J Med Sci 2001; 170:24-7. [PMID: 11440407 DOI: 10.1007/bf03167715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The longterm outlook after Helicobacter pylori (H. pylori) eradication in peptic ulcer disease is unclear. AIM This study documents H. pylori recurrence, dyspeptic symptoms and anti-secretory therapy in peptic ulcer patients six years or more after H. pylori eradication. METHODS Peptic ulcer patients with H. pylori eradication between 1990 and 1992 were included. Infection recurrence was diagnosed by 13-carbon urea breath test (UBT). Dyspeptic symptoms and anti-secretory therapy use were assessed by questionnaire. RESULTS Sixty-one patients completed the study protocol. Mean follow-up after eradication was 6.1 years (range 4.8-8.3). Four patients had a positive UBT. H. pylori recurrence rate was 6.6% or 0.02% per patient per year. Forty-two patients (69%) had dyspeptic symptoms. Heartburn and belching were more common than pain (p<0.001). All four patients with H. pylori recurrence had symptoms compared with 38 of 57 H. pylori-negative patients (p>0.05). Ten of 61 patients (16.4%) were taking anti-secretory therapy and their dyspepsia scores were higher. CONCLUSIONS Despite a low H. pylori recurrence rate, longterm dyspeptic symptoms were common in peptic ulcer patients after H. pylori eradication. The symptoms are mainly reflux in type and require anti-secretory therapy in only a minority of patients.
Collapse
Affiliation(s)
- H J O'Connor
- Department of Medicine, General Hospital, Tullamore, Co Offaly, Ireland
| | | | | | | | | |
Collapse
|
13
|
Louw JA, Marks IN. The treatment of peptic ulcer disease. Curr Opin Gastroenterol 2000; 16:489-94. [PMID: 17031126 DOI: 10.1097/00001574-200011000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
There is a continuation of the debate on the management of dyspepsia while the role of Helicobacter pylori in duodenal ulcer disease is being questioned with renewed vigor, specifically in the United States. The interaction of NSAIDs and H. pylori provided some interesting, if at times confusing, literature while the debate on the safety of long-term acid suppression remained unresolved. There were some interesting developments with regard to therapeutic agents during this period. A fourth proton pump inhibitor was introduced to the market while cisapride, a drug previously considered safe, was effectively withdrawn from the North American market because of safety concerns. More data on the COX-1-sparing agents became available, and their impressive gastrointestinal safety profile was confirmed. It was noted, however, that the incidence of dyspepsia, experienced by users of these drugs, may remain a problem.
Collapse
Affiliation(s)
- J A Louw
- New Groote Schuur Hospital, Cape Town, South Africa.
| | | |
Collapse
|
14
|
Abstract
New definitions of functional disorders in general and nonulcer dyspepsia in particular were published in the period of review. Although the definition of functional dyspepsia as persistent or recurrent unexplained upper abdominal pain or discomfort stayed essentially the same, new definitions of dyspepsia subgroups were introduced based on the predominant symptom; a reflux-like dyspepsia subgroup was not supported. It is hoped that these criteria, derived by a consensus among international experts in the field, will improve the reliability and the interpretability of future epidemiologic and interventional studies. A wide range of studies dealt with the role of putative etiological factors in functional bowel disorders including Helicobacter pylori, altered visceral sensation, or upper intestinal motility. Although eradication of H. pylori does not seem to relieve dyspepsia over placebo in recent studies of nonulcer dyspepsia, eradication of H. pylori has generally been advised because of suspected beneficial long-term effects (eg, treatment of misdiagnosed ulcer disease) that probably overweigh the potential risks.
Collapse
Affiliation(s)
- J Hammer
- Universitätsklinik für Innere Medizin IV, AKH Wien, Abteilung für Gastroenterologie und Hepatologie, Vienna, Austria
| | | |
Collapse
|
15
|
Janknegt R, Engels LG. Formulary Management of Eradication Therapies for Helicobacter pylori. ACTA ACUST UNITED AC 2000. [DOI: 10.2165/00115677-200007050-00003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|