HOW DO PRACTICING CLINICIAN MANAGE HELICOBACTER PYLORI-RELATED GASTROINTESTINAL-DISEASES IN GERMANY - A SURVEY OF GASTROENTEROLOGISTS AND FAMILY PRACTITIONERS

Background. Since the bacterium H. pylori was identified in 1982, over whelming evidence has implicated it as the causal factor in the occurr ence and relapse of peptic ulcer disease. The major objective of this study was to examine the extent to which physicians recognize H. pylor i as a causal agent in peptic ulcer disease or as potential cofactor i n other gastrointestinal diseases, and the extent to which this knowle dge has influenced diagnostic and therapeutic practices. Materials and Methods. Using a national mail survey in Germany in September 1995, 1 197 family practitioners and 1197 gastroenterologists were selected fo r the study. Results. Of the surveyed physicians, 756 (32%) responded. Family practitioners treated almost 50% of their patients with initia l presentation of suspected ulcer disease without ordering further dia gnostic tests. More than 25% of the family practitioners and 14% of th e gastroenterologists reported that they do not treat diagnosed H. pyl ori infection in the first presentation of duodenal ulcer. At the time we conducted the study, 22% of responding family practitioners and 5% of responding gastroenterologists treated the first presentation of H . pylori-positive ulcer disease with regimens determined to be ineffec tive according to the available literature. Conclusions. Gastroenterol ogists preferred to treat H. pylori infection when the associated dise ase was one for which a causal relationship had been more clearly esta blished, while family practitioners showed less discrimination. In ord er to provide optimal therapy aimed at minimizing the course and conse quences of H. pylori-related diseases, researchers in the field must e nsure continuous dissemination of current knowledge.