Skip to main content
SpringerLink
Log in

Helicobacter pylori Eradication Ameliorates Symptoms and Improves Quality of Life in Patients on Long-Term Acid Suppression: A Large Prospective Study in Primary Care

  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Our objective was to determine prescribing patterns for H2 receptor antagonists (H2RA) in primary care and to establish the prevalence and impact of Helicobacter pylori (Hp) eradication in this population of patients. Patients on long-term (6 months or longer) H2RA were identified through a computerized database at the six primary care practices in North England. Hp status was identified by serology, and those positive received standard proton pump-based triple therapy followed by a urea breath test to confirm Hp eradication. The main outcome measures were the indications for prescribing long-term H2RA in primary care, the prevalence of patients with a positive Hp serology, and the impact of Hp eradication on the subsequent need for acid suppression, severity of dyspepsia, gastrointestinal symptom rating score (GSRS), quality of life (QOL), and overall feeling of well-being. One thousand seven (1.5%) patients were on long-term H2RA. Peptic ulcer disease (PUD) was the most common indication for prescribing (42%), followed by nonulcer dyspepsia (28%) and gastroesophageal reflux disease (23%). In 81% of the patients treatment with H2RA therapy followed a previous endoscopic or radiological investigation. Only 27 (2.5%) patients had had their Hp status checked within the last 6 months. Of the 471 patients who eventually had their Hp serology tested, 297 (63%) were Hp positive. Fifty-eight percent of the Hp-positive patients had PUD. Successful Hp eradication was achieved in 250 (84%) of the patients, of whom 247 (83%) finished the 1-year follow-up. This was associated with a significant reduction in the amount of H2RA being consumed (P < 0.00001). There was also a significant improvement in the symptom scores and the GSRS after successful Hp eradication (P < 0.00001). Overall 67% of the patients reported an improvement in the QOL and 77% noted a feeling of well-being 1 year after Hp eradication. A significant proportion of patients in primary care is still being maintained on long-term H2RA, imposing a considerable financial drain on the NHS resources. Approximately two-thirds of these patients will be Hp positive, and among them the largest group will comprise patients with PUD. Hp eradication in such patients results in a significant reduction in usage of acid suppression and an improvement in overall QOL and severity of dyspeptic symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Ryder SD, O'Neill S, Miller RJ, Ross J, Jacana MR, Levi AJ: Long term acid suppressing treatment in general practice. BMJ 308:827–830, 1994

    Google Scholar 

  2. Gilliland AE, Mills KA, Irwin WG, Steele K: Patients on long term H2-receptor antagonists: are we investigating them? Fam Pract 7:43–46, 1990

    Google Scholar 

  3. Dammann HG, Walter TA: Efficacy of continuous therapy for peptic ulcer in controlled trials. Aliment Pharmacol Ther 7(Suppl 2):17–25, 1993

    Google Scholar 

  4. Hentschel E, Brandstatter G, Dragosics B, Hirschl A, Nemec H, Schutze K, Taufer M, Wurzer H: Effects of ranitidine and amoxycillin plus metronidazole on the eradication of HP and the recurrence of duodenal ulcer. N Engl J Med 328:308–312, 1993

    Google Scholar 

  5. Labenz J, Borsch G: Role of HP eradication in the prevention of peptic ulcer bleeding relapse. Digestion 55:19–23, 1994

    Google Scholar 

  6. Raws EA, Langenberg W, Houthoff HJ, Zanes HC, Tygat GN: Campylobacter pyloridis associated chronic active antral gastritis. A prospective study of its province and the effects of antimicrobial and antiulcer treatment. Gastroenterology 94:33–40, 1988

    Google Scholar 

  7. Rokkas T, Pursey C, Ugoechina E, Dorrington L, Simmons N, Filpe M, Sladen G: Campylobacter pylori and non ulcer dyspepsia. Am J Gastroenterol 82:1149, 1987

    Google Scholar 

  8. Tucci A, Corinaldesi R, Stanghellini V, et al: Helicobacter pylori infection and gastric function in patients with chronic idiopathic dyspepsia. Gastroenterology 103:768–774, 1992

    Google Scholar 

  9. Talley NJ, Janssens J, Lauritsen K, Racz I, Bolling-Sternevald E: Eradication of Helicobacter pylori in functional dyspepsia: randomised double blind placebo controlled trial with 12 months follow up. The optimal regimen cures Heliocobacter induced dyspepsia (ORCHID) study group. BMJ 27;318(187):833–837, 1999

    Google Scholar 

  10. McColl K, Murray L, El-Omar E, Dickson A, El-Nujumi A, Wirz A, Kelman A, Penny C, Knill Jones R, Hilditch J: Symptomatic benefit from eradicating Helicobacter pylori infection in patients with non ulcer dyspepsia. N Engl J Med 339(26):1869–1874, 1998

    Google Scholar 

  11. Norrelund N, Helles A, Schiegelow M: Uncharacteristic dyspepsia in general practice: Controlled trial with aluminium aminoacetate and magnesium hydroxide. Ugeskr Laeger 42:1750–1753, 1980

    Google Scholar 

  12. Talley NJ, Mcneil D, et al: Randomised double blind placebo controlled crossover trial of cimetidine and pirenzepine in non-ulcer dyspepsia. Gastroenterology 91:149–156, 1986

    Google Scholar 

  13. Fitzpatrick R, Fletcher A, Gore S, Jones D, Spiegelhalter D, Cox: Quality of life measures in health care.I. Aplication and issues in assessment. BMJ 305:1074–1077, 1992

    Google Scholar 

  14. Derogatis LR, Lopez MC: PAIS and PAIS-SR. Administration, Scoring and Procedures Manual. Baltimore: Johns Hopkins University School of Medicine, 1983

    Google Scholar 

  15. Stewart AL, Greenfield S, Hays RD, et al.: Functional status and well being of patients with chronic conditions. JAMA 262:907–913, 1989

    Google Scholar 

  16. Reilly TG, Ayres RCS, Poxon V, Walt RP: Helicobacter pylori eradication in a clinical setting: success rates and the effect on the quality of life in peptic ulcer. Aliment Pharmacol Ther 9:483–490, 1995

    Google Scholar 

  17. Wilhelmsen I: Quality of life in upper gastrointestinal disorders. Scand J Gastroenterol 30(Suppl 211):21–25, 1995

    Google Scholar 

  18. Brody TJ, Andrews P, Shortis NP: Evaluation of whole blood antibody kit to detect active helicobacter pylori infection. Am J Gastroenterol 91:2509–2512, 1996

    Google Scholar 

  19. Dimenas E, Glise H, Hallerback B, Hernqvist H, Svedlund J, Wicklund I: Quality of life in patients with upper gastrointestinal symptoms. Scand J Gastroenterol 28:681–687, 1993

    Google Scholar 

  20. Jones RH, Lydeard SE, Hobbs FD, Kenkre JE, Williams EI, Jones SJ, Repper JA, Caldow JL, Dunwoodie WM, Bottonley JM: Dypepsia in England and Scotland. Gut 31:401–405, 1990

    Google Scholar 

  21. Penston JG, Pounder RE: A survey of dyspepsia in Great Britain. Aliment Pharmacol Ther 10:83–89, 1996

    Google Scholar 

  22. H2-receptor antagonists. MeReC Bull 1:9–11, 1990

    Google Scholar 

  23. Fendrick AM, Hirth RA, Chernew ME: Differences between generalists and specialist physicians regarding Helicobacter pylori and peptic ulcer disease. Am J Gastroenterol 91:1544–1548, 1996

    Google Scholar 

  24. Breuer T, Goodman K, Malaty H, Sudhop T, Graham DY: How do clinicians practicing in the US manage Helicobacterpylori related gastrointestinal disease? Am J Gastroenterol 93(4):553–561, 1998

    Google Scholar 

  25. Duggan A, Logan R, Knifton A, Logan R: Accuracy of near patient blood tests for Helicobacter pylori. Lancet 348:617, 1996

    Google Scholar 

  26. Phull PS, Ryder SD, Halliday D, Price AB, Jaacyna MR: The economic and quality of life benefits of Helicobacter pylori eradication in chronic duodenal ulcer disease—A community based study. Postgrad Med J 71:413–418, 1995

    Google Scholar 

  27. Tucci A, Corinaldesi R, Stanghellini V, Tosetti C, DiFebo G, Paparo G: Helicobacter pylori infection and gastric function in patients with chronic idiopathic dyspepsia. Gastroenterology 103:768–774, 1992

    Google Scholar 

  28. Svedlund J, Sjodin I, Doteval G: GSRS—A clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Dig Dis Sci 33:129–134, 1998

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ, UK

    S. Verma & M.H. Giaffer

Authors
  1. S. Verma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M.H. Giaffer
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Verma, S., Giaffer, M. Helicobacter pylori Eradication Ameliorates Symptoms and Improves Quality of Life in Patients on Long-Term Acid Suppression: A Large Prospective Study in Primary Care. Dig Dis Sci 47, 1567–1574 (2002). https://doi.org/10.1023/A:1015823320831

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1015823320831

Search

Navigation