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Implications of Helicobacter pylori: ‘test-and-treat’ approach in a primary-care setting

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Helicobacter pylori

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Abstract

The availability of accurate and inexpensive non-invasive tests for H. pylori coupled with effective, safe treatment to eradicate the bacteria, provide a strong impetus for a ‘test-and-treat’ approach to dyspepsia in the primary-care setting. Proponents of this approach point out that eradicating H. pylori in dyspeptic patients is cost-effective, relieving symptoms in some, thereby eliminating the need for expensive, invasive tests and chronic medication. Opponents argue that symptomatic benefit is inconsistent and short-lived at best, so that most dyspeptic patients eventually undergo evaluation to establish a clinical diagnosis and/or to allay anxiety concerning the possibility of a serious underlying disease. Unfortunately, there are few reliable clinical data to guide management decisions, but the reality of clinical practice does require integration of H. pylori eradication into the management of dyspepsia. What diagnostic tests for H. pylori are appropriate in the primary-care setting? Which treatment regimens should be used by primary-care physicians? In which patients is it cost-effective to test for and treat H. pylori? These issues all impact on the primary-care approach to H. pylori.

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References

  1. Cutler AF, Haystad S, Ma CK et al. Accuracy of invasive and noninvasive tests to diagnose Helicobacter pylori infection. Gastroenterology. 1995;109:136–41.

    Article  PubMed  CAS  Google Scholar 

  2. Mégraud F. Diagnosis and candidates for treatment of Helicobacter pylori infection: how should Helicobacter pylori infection be diagnosed? Gastroenterology. 1997;113:S93–8.

    Article  PubMed  Google Scholar 

  3. The European Helicobacter pylori study group. Current European concepts in the management of Helicobacter pylori infection. The Maastricht consensus report. Gut. 1997;41:8–13.

    Google Scholar 

  4. The report of the Digestive Health InitiativesM International Update Conference on Helicobacter pylori. Gastroenterology. 1997;113:54–8.

    Google Scholar 

  5. Graham DY, Evans DJE, Peacock J et al. Comparison of rapid serological tests (Flexsure HP and QuickVue) with conventional ELISA for detection of Helicobacter pylori infection. Am J Gastroenterol. 1996;91:942–8.

    PubMed  CAS  Google Scholar 

  6. Cutler AF, Prasad VM. Long-term follow-up of Helicobacter pylori serology after successful eradication. Am J Gastroenterol. 1996;91:85–8.

    PubMed  CAS  Google Scholar 

  7. Peura DA, Pambianco DJ, Dye KR et al. Microdose 14C-urea breath test offers diagnosis of Helicobacter pylori in 10 minutes. Am J Gastroenterol. 1996;91:233–8.

    PubMed  CAS  Google Scholar 

  8. Bazzoli F, Zagari M, Fossi Set al. Urea breath tests for the detection of Helicobacter pylori infection. Helicobacter. 1997;2:S34–7.

    Article  PubMed  Google Scholar 

  9. Chey WD, Woods M, Scheiman JR et al. Lansoprazole and ranitidine affect the accuracy of the 14C-urea breath test by a pH-dependent mechanism. Am J Gastroenterol. 1997;92:446–50.

    PubMed  CAS  Google Scholar 

  10. Trevasani L, Sartori S, Galvani F et al. Two unusual techniques for diagnosing Helicobacter pylori infection. Gastroenterol Int. 1997;10:58–60.

    Google Scholar 

  11. Reilly TG, Poxon V, Sanders DSA et al. Comparison of serum, salivary, and rapid whole blood diagnostic tests for Helicobacter pylori and their validation against endoscopy based tests. Gut. 1997;40:454–8.

    PubMed  CAS  Google Scholar 

  12. Simor AE, Lin E, Saibil F et al. Evaluation of enzyme immunoassay for detection of salivary antibody to Helicobacter pylori. J Clin Microbiol. 1996;34:550–3.

    PubMed  CAS  Google Scholar 

  13. Kim MJ, Michener R, Triadafilopoulos G. Serum 13C-bicarbonate assay for the diagnosis of gastric Helicobacter pylori infection and response to treatment. Gastroenterology. 1997;113:31–7.

    Article  PubMed  CAS  Google Scholar 

  14. Breuer T, Malaty HM, Goodman K et al. Treatment regimens used in Helicobacter pylori positive ulcer disease; a nationwide comparison of gastroenterologists and family practitioners in the United States of America. Gut. 1996;39:A22.

    Google Scholar 

  15. Hopkins RJ. Current FDA-approved treatments for Helicobacter pylori and the FDA approval process. Gastroenterology. 1997;113:S126–30.

    Article  PubMed  CAS  Google Scholar 

  16. Fennerty MB. Treatment goals and treatment options of Helicobacter pylori: what are the treatment goals for Helicobacter pylori infection? Gastroenterology. 1997;113:5120–5.

    Google Scholar 

  17. Vakil N, Fennerty M. Cost-effectiveness of treatment regimens for H. pylori infection based on a community practice effectiveness study. Gastroenterology. 1997;112:A47 (abstract).

    Google Scholar 

  18. Huang J-O, Chiba N, Wilkinson JM et al. Which combination therapy can eradicate 90% Helicobacter pylori (H. pylori) infection? A meta-analysis of amoxicillin, metronidazole, tetracycline and clarithromycin containing regimens. Gastroenterology. 1997;112:A19.

    Google Scholar 

  19. Penston JG, McColl KEL. Eradication of Helicobacter pylori: an objective assessment of current therapies. Br J Clin Pharmacol. 1997;43:223–43.

    Article  PubMed  CAS  Google Scholar 

  20. Graham DY, de Boer WA, Tytgat GNJ. Choosing the best anti-Helicobacter pylori therapy: effect of antimicrobial resistance. Am J Gastroenterol. 1996;91:1072–6.

    PubMed  CAS  Google Scholar 

  21. Mégraud F, Lehn N, Lind T et al. The Mach 2 study. Helicobacter pylori resistance toantimicrobial agents and its influence on clinical outcome. Gastroenterology. 1997;112:A216.

    Google Scholar 

  22. Graham DY, Lew GM, Malaty HM et al. Factors influencing the eradication of Helicobacter pylori with triple therapy. Gastroenterology. 1992;102:493–6.

    PubMed  CAS  Google Scholar 

  23. NIH Consensus Development Panel on Helicobacter pylori in Peptic Ulcer Disease. Helicobacter pylori in peptic ulcer disease. J Am Med Assoc. 1994;272:65–9.

    Article  Google Scholar 

  24. Fendrick AM, McCort JT, Chernew ME et al. Immediate eradication of Helicobacter pylori in patients with previously documented peptic ulcer disease: clinical and economic effects. Am J Gastroenterol. 1997;92:2017–24.

    PubMed  CAS  Google Scholar 

  25. Bodger K, Daly MJ, Heatley RV. Clinical economics review: Helicobacter pylori-associated peptic ulcer disease. Aliment Pharmacol Ther. 1997;11:273–82.

    Article  PubMed  CAS  Google Scholar 

  26. Wilhelmsen I. Quality of life and Helicobacter pylori eradication. Scand J Gastroenterol. 1996;221:18–20.

    Article  CAS  Google Scholar 

  27. Sonnenberg A. Comparative cost-effectiveness of three ulcer therapies. Gastroenterology. 1997;122:A43.

    Google Scholar 

  28. Talley NJ. A critique of therapeutic trials in Helicobacter pylori-positive functional dyspepsia. Gastroenterology. 1994;106:1174–83.

    PubMed  CAS  Google Scholar 

  29. Heikkinen M, Pikkarainen P, Takala J et al. Etiology of dyspepsia: four hundred unselected consecutive patients in general practice. Scand J Gastroenterol. 1995;30:519–23.

    Article  PubMed  CAS  Google Scholar 

  30. Talley NJ, Zinsmeister AR, Schleck CD et al. Dyspepsia and dyspepsia subgroups: a population-based study. Gastroenterology. 1992;102:1259–68.

    PubMed  CAS  Google Scholar 

  31. Lim AG, Martin RM, Montileone M et al. Helicobacter pylori serology and the management of young dyspeptics: a UK survey of gastroenterologists and general practitioners with an interest in gastroenterology. Aliment Pharmacol Ther. 1997;11:299–303.

    Article  PubMed  CAS  Google Scholar 

  32. Breuer T, Malaty HM, Goodman K et al. Does disease presentation influence treatment of Helicobacter pylori infection? A nationwide comparison of gastroenterologists and family practitioners in the United States of America. Gut. 1996;39:A21.

    Article  Google Scholar 

  33. Laheij RJF, Jansen JBMJ, van de Lisdonk EH et al. Review article: Symptom improvement through eradication of Helicobacter pylori in patients with non-ulcer dyspepsia. Aliment Pharmacol Ther. 1996;10:843–50.

    Article  PubMed  CAS  Google Scholar 

  34. Ofman JJ, Etchason J, Fullerton S et al. Management strategies for Helicobacter pyloriseropositive patients with dyspepsia: clinical and economic consequences. Ann Intern Med. 1997;126:280–91.

    PubMed  CAS  Google Scholar 

  35. Rubin RJ, Cascade EF, Barker RC et al. Management of dyspepsia: a decision analysis model. Am J Managed Care. 1996;2:647–55.

    Google Scholar 

  36. Sonnenberg A. Cost-benefit analysis of testing for Helicobacter pylori in dyspeptic subjects. Am J Gastroenterol. 1996;91:1773–7.

    PubMed  CAS  Google Scholar 

  37. Asaka M, Takeda H, Sugiyama T et al. What role does Helicobacter pylori play in gastric cancer? Gastroenterology. 1997;113:S56–60.

    Article  PubMed  CAS  Google Scholar 

  38. IARC Monographs on the evaluation of carcinogenic risks to humans Schistosomes, liver flukes and Helicobacter pylori. In: International Agency for Research on Cancer Monograph 61, Lyon, France, 1994:177–240.

    Google Scholar 

  39. Parsonnet J, Harris RA, Hack HM et al. Modeling cost-effectiveness of Helicobacter screening to prevent gastric cancer: A mandate for clinical trials. Lancet. 1996;348:150.

    Article  PubMed  CAS  Google Scholar 

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Authors
  1. D. A. Peura
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Editors and Affiliations

  1. Division of Gastroenterology, McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada

    Richard H. Hunt (Professor of Medicine, Director) (Professor of Medicine, Director)

  2. Department of Gastroenterology and Hepatology, Academic Medical Centre, 9 Meibergdreef, 1105 AZ, Amsterdam, The Netherlands

    Guido N. J. Tytgat (Professor) (Professor)

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© 1998 Springer Science+Business Media Dordrecht

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Peura, D.A. (1998). Implications of Helicobacter pylori: ‘test-and-treat’ approach in a primary-care setting. In: Hunt, R.H., Tytgat, G.N.J. (eds) Helicobacter pylori. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-4882-5_27

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  • DOI: https://doi.org/10.1007/978-94-011-4882-5_27

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-6046-2

  • Online ISBN: 978-94-011-4882-5

  • eBook Packages: Springer Book Archive

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