Survey of current practices among members of CAG in the follow-up of patients diagnosed with gastric ulcer

INTRODUCTION: Guidelines recommend a policy of endoscopic follow-up of all gastric ulcers until hearing. Analysis of data from the Alberta Endoscopy P roject indicates that fewer than 50% of patients diagnosed with benign gast ric ulcer had undergone a repeat procedure. The practice and attitudes of p hysician members of the Canadian Association of Gastroenterology (CAG) on t he follow-up of such patients were assessed. METHODS: A self-administered questionnaire was mailed to members of CAG. Re spondents were asked to indicate their practice setting and to estimate the proportion of gastric ulcer patients in whom they perform follow-up endosc opy. They were also asked to indicate factors influencing this choice, incl uding the role of Helicobacter pylori. RESULTS: Fifty seven per cent of 220 respondents indicated that they perfor m repeat endoscopy in 95% to 100% of individuals with benign gastric ulcer. The most common reasons influencing this choice were to ensure healing (86 .3%) and to confirm the benign nature of the lesion (79.5%). Nonsteroidal a ntiinflammatory drug (NSAID) use (83.2%) and patient ill health (62.9%) wer e the most common reasons for not repeating the endoscopy. Twenty per cent of individuals indicated that H pylori had influenced a change in their pra ctice. DISCUSSION: Physicians vary widely in their follow-up of benign gastric ulc er. Studies on the occurrence of gastric cancer in this setting are not una nimous in their conclusions. Subgroups of patients with NSAID exposure and successfully eradicated H pylori infection may have a lower risk of maligna ncy. Studies to confirm this are warranted, and modified guidelines may be appropriate.