THE ROLE OF SCREENING FOR HELICOBACTER-PYLORI IN PATIENTS WITH DUODENAL ULCERATION IN THE PRIMARY HEALTH-CARE SETTING

Background. It is known that at least 90% of duodenal ulcers are cause d by infection with the bacterium Helicobacter pylori. Eradicating thi s organism usually results in complete resolution of the disease. Test ing for H pylori was introduced relatively recently, and thus, many pa tients known to have uncomplicated peptic ulcer disease who continue t o need long-term treatment with ulcer-healing drugs have never been te sted for the infection or offered eradication therapy. In modern compu terized practices, this subgroup of patients can readily be identified by reference to morbidity and repeat prescribing data. Eradication of H pylori infection in this group of patients has great potential bene fit for the individuals concerned as well as cost-saving benefit for t he National Health Service. Aim. The aim of this prospective study was to determine whether it is worthwhile screening for and treating H py lori infection in patients in a general practice population with previ ously diagnosed duodenal ulcer disease taking ulcer-healing drugs long term. Method. In 1994, in a practice of 7100 patients, morbidity and repeat prescribing data were used to identify 40 patients (0.6%) with proven duodenal ulcer disease taking ulcer-healing medication long ter m and with uncertain H pylori status. Twenty-nine of the 40 subjects a greed to undergo serology testing for H pylori antibodies. Of 20 (69%) who were positive, 18 (eight women, median age 63.8 years) were given eradication therapy. Seventeen patients received omeprazole 40 mg onc e daily and amoxycillin 500 mg three times daily for 14 days with metr onidazole 400 mg three times daily for the first 7 days; for the remai ning patient metronidazole was inadvertently omitted. [C-13]Urea breat h testing was carried out at the local hospital at least one month aft er therapy to determine whether eradication treatment had been success ful. Subjects were also personally followed up by telephone after 1 an d 4 months to assess the success of treatment subjectively. Results. [ (13)]Urea breath testing showed that H pylori eradication was successf ul in all 17 patients (100%) who received the intended eradication reg imen. Helicobacter pylori was not eradicated in the patient who receiv ed only omeprazole and amoxycillin. Four months after successful H pyl ori eradication, 13 of the 17 (76%) patients remained completely asymp tomatic. Two of the four patients who had some recurrent dyspepsia had known gastro-oesophageal reflux and their ongoing symptoms after erad ication therapy seemed, on close questioning, to be more attributable to this than to duodenal ulcer disease. Conclusion. Testing for and er adication of H pylori is worthwhile in general practice in those patie nts with previous proven duodenal ulceration who need long-term ulcer- healing medication. The high rate of eradication of H pylori achieved with the regimen used in this study compares very favourably with that of other treatment regimens. However. in patients with duodenal ulcer s there may be coexisting pathology, and H pylori eradication does not necessarily result in complete disappearance of dyspeptic symptoms. T hus, when monitoring the outcome of treatment it is important to asses s improvement of symptoms as well as objective evidence of eradication .