UPPER GASTROINTESTINAL-DISEASE IN SCOTLAND - A SURVEY OF PRACTICE AMONGST SCOTTISH GASTROENTEROLOGISTS

Given the range of causes of upper gastrointestinal disease (UGD), the evolving role of Helicobacter pylori in its pathogenesis and the vari ety of treatments available, one might expect complex management strat egies in the management of these diseases. The aim of this study was t o determine the current management strategies used in peptic nicer dis ease and gastritis in Scotland and to identify areas where large and c linically important variations in practice exist between gastro-intest inal specialists, Between Tune and September 1994, 130 gastro-intestin al physicians and surgeons were sent a postal questionnaire based on t heir response to four hypothetical clinical scenarios. Eighty-one (63% ) correspondents returned completed questionnaires, The case histories related tc,: bleeding duodenal ulcer; peptic ulceration whilst taking non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids; m anagement of dyspepsia in the young; and management of gastritis, Thir ty-eight per cent of clinicians surveyed advocated the use of intraven ous acid reducing agents in peptic ulcer bleeding, A total of 88% advo cated endoscopic therapy in the presence of stigmata of recent haemorr hage and 5% suggested a follow up of endoscopy to confirm healing afte r ulcer bleeding, In treating the patient with ulcer while on NSAIDs, 45% of clinicians would use H2 receptor antagonists, 37% would use ome prazole, 14% misoprostol and 4% helicobacter eradication. Of the clini cians surveyed, 63% said they would investigate a 25-year-old patient with dyspepsia by endoscopy and 84% of these will biopsy for H. pylori . Empirical treatment was favoured by 37% and 4% considered a barium m eal, There was no consensus in the treatment of gastritis. There exist s considerable divergence of opinion between clinicians in investigati on find treatment of upper gastrointestinal disease, The role of endos copy, the type and duration of medical medical treatment of bleeding a nd non bleeding ulcer and gastritis require further, more detailed inv estigation. A consensus document would be warmly welcomed.