A survey of internal medicine residents' knowledge about Helicobacter pylori infection

OBJECTIVE: Despite recently published national guidelines, many physicians have only limited knowledge about Helicobacter pylori infection. We conduct ed this study to assess internal medicine residents' knowledge about H. pyl ori. METHODS: Two hundred and nineteen residents in seven accredited internal me dicine training programs completed a self-administered questionnaire on per sonal demographics and practices related to testing for-and treating-H. pyl ori infection. RESULTS: Noon conferences (82%), ward teaching (66%), journals (70%), and s ponsored symposia (27%) were their major sources of H. pylori-related infor mation. Forty-eight percent had used office-based tests for the infection. Testing for (and treatment of) Helicobacter pylori infection was recommende d by 97% (97%) for newly diagnosed duodenal ulcer, but by only 61% (63%) fo r a past history of duodenal ulcer. Many recommended testing in unproven co nditions and might not have offered treatment to an infected patient. A pro ton pump inhibitor-based triple-drug regimen was the treatment of first cho ice of 55%; 20% recommended proton pump inhibitor-based dual regimens. Sixt y-six percent and 80%, respectively, underestimated the rates of resistance to clarithromycin and metronidazole. In the absence of gastrointestinal sy mptoms, 22% would have ordered Helicobacter pylori testing but only 33% of these would undergo treatment if positive. CONCLUSIONS: Internal medicine residents usually test for Helicobacter pylo ri infection in appropriate conditions, but may not always treat the infect ion when the result is positive. Most use efficacious treatment regimens al though many have inaccurate knowledge of resistance rates, which may advers ely influence prescribing. Education should focus on practical issues surro unding Helicobacter pylori testing and treatment such as those contained in the American College of Gastroenterology's 1998 practice guidelines. (C) 2 000 by Am. Cell. of Gastroenterology.