HOW DO CLINICIAN PRACTICING IN THE US MANAGE HELICOBACTER PYLORI-RELATED GASTROINTESTINAL-DISEASES - A COMPARISON OF PRIMARY-CARE AND SPECIALIST PHYSICIANS

Objectives: We sought to examine the extent to which physicians recogn ize H. pylori as a causal agent in peptic ulcer disease or as a potent ial cofactor in other gastrointestinal diseases, and to observe how th is knowledge has influenced diagnostic and therapeutic practices. Meth ods: We used a national mail survey in the U.S. between February and M ay of 1996, querying 5994 U.S. physicians (family/general practitioner s [FPs], internists [IMs], and gastroenterologists) selected at random from three different membership databases of professional association s. Results: The response rate was 52%. More than 95% of physicians who treat symptoms empirically would prescribe acid suppressant therapy r ather than anti-H. pylori therapy. Between 43% and 66% of physicians, varying in frequency by medical specialty, would treat the infection i n H. pylori-positive patients with nonulcer dyspepsia. In confirmed pe ptic ulcer disease, between 88% and 100% of physicians would treat the H. pylori infection, depending on the physician group and whether or not the presentation of an ulcer was recurrent. Although 103 distinct anti-H. pylori regimens were reported, 89% of the gastroenterologists and 70% of the primary care physicians (PCPs) used combinations of ant imicrobials with reported cure rates of at least 80%. Conclusions: Gen eral knowledge regarding H. pylori-associated diseases was widespread among primary care physicians and gastroenterologists. However, anti-H . pylori therapies judged ineffective were reported as the first choic e regimen by 5% of gastroenterologists and 18% of primary care physici ans. Gastroenterologists appear to implement the latest scientific dev elopments in the field rapidly whereas PCPs manifest a delayed respons e, due to either insufficient knowledge or to other factors influencin g their approach to treatment. (C) 1998 by Am. Coll. of Gastroenterolo gy.