Lack of Symptom Relief Following Presumptive H pylori Eradication Therapy in Primary Care
Lack of Symptom Relief Following Presumptive H pylori Eradication Therapy in Primary Care
Abstract & Commentary
Synopsis: The eradication of Helicobacter pylori in primary care does not produce long-term benefits in terms of the avoidance of future need for antisecretory therapy.
Source: Williams D, et al. Aliment Pharmacol Ther. 2001; 15:1769-1775.
Dyspepsia is extremely common and is said to account for 2-3% of all primary care consultations in the United Kingdom.1
"Ulcer-healing" drugs, largely prescribed for gastroesophageal reflux disease (GERD) and dyspepsia, account for a full 10% of all British drug costs, and US data are quantitatively similar. Once ulcer disease and Helicobacter pylori were etiologically linked along with an apparent association between H pylori infection and dyspepsia, empirical eradication of H pylori in uninvestigated dyspepsia has been widely encouraged.
This study assessed a large prescription database in Ireland to identify patients who received H pylori eradication therapy. It was then determined whether such patients subsequently received further antisecretory therapy. In Ireland, 3847 primary care patients received 3851 prescriptions for one of the standard H pylori eradication regimens. Median follow-up was 8 months in the overall group. The overall "failure rate" (ie, need for further antisecretory therapy) was 49% with no significant differences between various eradication regimens. Particularly high failure rates were seen in elderly patients, those previously receiving antisecretory therapy prior to an eradication regimen, and in patients on NSAIDs.
Comment Malcolm Robinson MD, FACP, FACG
More than half of all patients receiving H pylori eradication therapy in primary care settings require further antisecretory medications. Some of these patients might have received therapy in the absence of clearly documented H pylori infection, and the precise indications for therapy were not known in this particular study. Nevertheless, this study provides no evidence whatsoever that would support the use of H pylori eradication therapy in primary care settings as a means of averting the future need for antisecretory therapy. Patients older than age 65 and those on aspirin were particularly likely to fail in this setting. Thus, the hoped for and promised fiscal benefits from eradication therapy seem unlikely to be realized. All in all, most studies of H pylori eradication in dyspepsia continue to show the futility of this approach.
Reference
1. Penston J, Pounder R. Aliment Pharmacol Ther. 1996;10:83-89.
Dr. Robinson, Medical Director, Oklahoma Foundation for Digestive Research; Clinical Professor of Medicine, University of Oklahoma College of Medicine, Oklahoma City, OK, is Associate Editor of Internal Medicine Alert.
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