Treatment of H. pylori infection in primary care – Tips from Other Journals
Grace Brook Huffman
Many studies of the treatment of Helicobacter pylori infection have been performed in patients with ulcer disease related to this organism and have shown that treatment can result in cure of peptic ulcer disease. However, whether similar highly successful outcomes can be achieved in clinical practice (as opposed to a highly motivated study population) is less certain, given the complexity of treatment regimens. Gomollon and colleagues conducted a prospective study to evaluate the success of treatment in a primary care practice.
The study included 31 patients with active peptic ulcer disease who were seen in a primary care center in Spain. Patients were initially diagnosed as having peptic ulcer disease and H. pylori infection by endoscopy with biopsy and a positive urease test. The patients’ primary care physician then prescribed a 14-day oral course of omeprazole (20 mg daily), tetracycline (500 mg four times daily), bismuth subcitrate (120 mg four times daily) and metronidazole (250 mg three times daily). A follow-up visit was scheduled on day 15 and a follow-up endoscopy on day 45. Symptoms and side effects were reviewed with each patient.
Twenty-eight of the patients agreed to the second endoscopy. All of these patients had complete healing of the ulcer demonstrated on the endoscopy, and none of the patients had more than mild symptoms remaining (if any at all). H. pylori was eradicated in 25 (89.3 percent) of the patients. More than one half of the patients had side effects, but most (73 percent) reported them as mild. The most common side effects were diarrhea (25.0 percent), metallic taste (17.8 percent) and headache (10.7 percent). At a six-month follow-up visit, 92 percent of the patients reported satisfaction with the treatment received.
The authors conclude that, although the treatment regimens for H. pylori are somewhat complex, primary care physicians can feel confident that a high rate of cure (H. pylori eradication and ulcer healing) can be achieved at a reasonable cost.
Gomollon F, et al. Eradication of Helicobacter pylori among patients from a primary care practice. J Fam Pract 1996;43(6):551-5.
COPYRIGHT 1997 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group