ROLE OF HELICOBACTER-PYLORI IN GASTROINTESTINAL-DISEASE - IMPLICATIONS FOR PRIMARY-CARE OF A REVOLUTION IN MANAGEMENT OF DYSPEPSIA

The majority of patients with dyspepsia are managed in general practic e. However, most of the literature on Helicobacter pylori and its asso ciation with gastrointestinal disease has originated from secondary ca re. This review summarizes the role of H pylori in dyspepsia from the perspective of primary care and suggests a new strategy for the manage ment of dyspeptic patients in this setting. Recent meta-analyses and c onsensus statements have supported the use of eradication therapy as f irst-line treatment of peptic ulceration. Studies from primary care ha ve supported the use of eradication therapy in patients who have H pyl ori related peptic ulcer disease and require longterm H-2-antagonist m edication, on both clinical benefit and cost-effectiveness grounds. Of the many regimens proposed for the eradication of H pylori, the best evidence supports a triple combination of bismuth, metronidazole and t etracycline. Regimens using proton pump inhibitors may be more accepta ble to patients but lack good evidence from trials. Use of a positive serum enzyme-linked immunoabsorbent assay for H pylori antibodies as a criterion for endoscopic investigation has been shown to result in a 23% reduction in endoscopic workload. Further research should answer q uestions of importance to general practitioners, such as the role of e radication therapy in patients with nonulcer dyspepsia and the effecti veness of eradication of H pylori in the prevention of gastric cancer.