Are guidelines followed in Helicobacter pylori diagnosis and therapy? An inquiry among gastroenterologists, referring physicians and patients in Munich

Background and study aims: Attempts to standardize Helicobacter pylori (Hp) diagnosis and therapy have led to the publication of guidelines by various national gastroenterological societies in Europe and the USA. However, lit tle information is available either regarding the compliance of gastroenter ologists and referring physicians with these guidelines, or regarding the p atients' perspective. Patients and Methods: A retrospective analysis was conducted of all outpati ent upper gastrointestinal endoscopy reports for a one-month period in elev en different centers (two university hospitals and nine private practice ga stroenterology offices) with a total of 24 gastroenterologists. Endoscopy r eports from patients with the indications of reflux, diarrhea, and tumors w ere excluded. Diagnoses and treatment recommendations given by gastroentero logists were recorded. Questionnaires concerning Up diagnosis, treatment in dications and performance, and follow-up were sent to referring physicians and patients. Results: A total of 772 endoscopy reports were included in the study; analy zable questionnaires were returned by 287 referring physicians (47%) and by 265 patients (59%). Gastroenterologists recommended lip eradication in all ulcers and in 29% of gastritis/nonulcer dyspepsia (NUD) cases. Referring p hysicians thought that 94% of ulcers should be treated by Hp eradication, w hich was also considered to be an absolute and relative indication in NUD b y 15% and 53% of the referring physicians, respectively. Among the patients who replied, 52% had received Hp eradication regimens; ulcers were found i n 22% of the total patient group. Check-up examinations after Hp therapy we re considered necessary by 75% of the referring physicians, but only 22% of the responding patients actually underwent some form of check-up (upper ga strointestinal endoscopy in 91%). Conclusions: Gastroenterologists and (to a somewhat lesser extent) referrin g physicians appear to be following the current guidelines for lip treatmen t. As expected, two thirds of referring physicians consider NUD to be an ab solute or relative indication for Hp eradication. Check up examinations are apparently being performed less frequently than recommended.