Weijnen C F, de Wit N J, Numans M E, Quartero A O, Verheij T J
Julius Center for General Practice and Patient-Oriented Research, University Medical Center, Utrecht, The Netherlands.
Digestion. 2001;64(1):40-5. doi: 10.1159/000048837.
Many guidelines on the management of Helicobacter pylori (HP)-related dyspepsia have been launched over the past decade. The suggested policies in these guidelines are often more consensus- than evidence-based (test-and-treat policy, test and endoscope), which may cause confusion among primary-care physicians.
To determine the current management of HP-related dyspepsia by Dutch general practitioners (GPs).
A random sample of 5% of all Dutch GPs (n = 355) were sent a questionnaire on the diagnosis and treatment of HP infections in dyspepsia management.
The response rate was 66.2% (n = 235). Almost 80% of the responding GPs stated they had conducted HP testing (via endoscopy or serology) during the previous 12 months. In the same time period, more than 94% had actually prescribed a HP eradication therapy. A total of 70% of the GPs stated that they used endoscopy to test for HP infection, 54% used serology (ELISA); whole-blood tests and carbon urea breath tests were not used. Patients with a history of peptic ulcer disease, those on chronic acid-suppressive drugs and patients with recurrent ulcer-like complaints were most frequently tested for HP infection.
Given the frequency of consultations for dyspepsia in primary care in the Netherlands (150 new dyspeptic patients per average practice per year), and the reported average number of HP tests performed (1-5 per GP per year), HP diagnosis plays a modest role in the management of dyspepsia in Dutch general practices. Neither the 'test-and-treat' policy recommended in the Maastricht guidelines, nor its advice regarding the choice of diagnostic tests (carbon urea breath test or serology), is being followed. The majority of GPs uses endoscopy for the detection of HP infection.
在过去十年中，已经发布了许多关于幽门螺杆菌（HP）相关性消化不良管理的指南。这些指南中建议的策略通常更多是基于共识而非证据（检测与治疗策略、检测与内镜检查），这可能会使基层医疗医生感到困惑。
确定荷兰全科医生（GP）对HP相关性消化不良的当前管理方式。
向所有荷兰全科医生的5%（n = 355）随机抽样发送一份关于消化不良管理中HP感染诊断和治疗的问卷。
回复率为66.2%（n = 235）。近80%的回复全科医生表示，他们在过去12个月内进行了HP检测（通过内镜检查或血清学检测）。在同一时期，超过94%的医生实际开出了HP根除治疗处方。共有70%的全科医生表示他们使用内镜检查来检测HP感染，54%使用血清学检测（酶联免疫吸附测定法）；未使用全血检测和碳尿素呼气试验。有消化性溃疡病史的患者、长期服用抑酸药物的患者以及有复发性溃疡样症状的患者接受HP感染检测的频率最高。
考虑到荷兰基层医疗中消化不良的就诊频率（平均每个诊所每年有150名新的消化不良患者），以及报告的HP检测平均数量（每位全科医生每年1 - 5次），HP诊断在荷兰全科医疗中对消化不良的管理作用不大。马斯特里赫特指南中推荐的“检测与治疗”策略及其关于诊断检测选择（碳尿素呼气试验或血清学检测）的建议均未得到遵循。大多数全科医生使用内镜检查来检测HP感染。
