Shirin Haim, Birkenfeld Shlomo, Shevah Orit, Levine Arie, Epstein Julia, Boaz Mona, Niv Yaron, Avni Yona
Department of Gastroenterology, the E Wolfson Medical Center, Holon, Israel.
J Clin Gastroenterol. 2004 Apr;38(4):322-5. doi: 10.1097/00004836-200404000-00005.
The Maastricht 2-2000 guidelines on the current management of Helicobacter pylori infection were recently adopted by the Israeli Gastroenterological Association.
To determine the impact of these clinical guidelines on the current knowledge, attitudes, and management of H. pylori among primary care physicians, hospital internists, and gastroenterologists in Israel.
Self-administered, voluntary, anonymous questionnaires were given personally to 229 physicians, 73 primary care physicians, 71 internists, and 85 gastroenterologists. The questions evaluated 4 main issues in the management of H. pylori: (1). the optimal diagnostic test, (2). indications for eradication, (3). combination and duration of triple therapy, and (4). the need for confirmation following eradication.
There were significant variations in the adherence of those recommendations among gastroenterologists, internists, and primary care physicians. Specifically, 94.1% of gastroenterologists and 88.9% of internists consider the urea breath test the test of choice for H. pylori diagnosis compared with 60.0% of the primary care physicians. Significant differences in the eradication indications for mucosa-associated lymphoid tissue (MALT) lymphoma, first-degree relatives of gastric cancer patients, atrophic gastritis, functional dyspepsia, and concomitant use of nonsteroidal antiinflammatory drugs were demonstrated among gastroenterologists and the other groups.
Primary care physicians may not be aware of important indications for diagnosis and eradication of H. pylori related to the risk of gastric malignancy or concomitant use of nonsteroidal antiinflammatory drugs. Public health agencies may need to increase penetration of the Maastricht 2000 recommendations to primary care physicians.
以色列胃肠病学协会最近采用了关于幽门螺杆菌感染当前管理的马斯特里赫特2-2000指南。
确定这些临床指南对以色列初级保健医生、医院内科医生和胃肠病学家当前对幽门螺杆菌的认识、态度和管理的影响。
自行填写、自愿、匿名的问卷被亲自分发给229名医生，其中73名初级保健医生、71名内科医生和85名胃肠病学家。这些问题评估了幽门螺杆菌管理中的4个主要问题：（1）最佳诊断测试，（2）根除指征，（3）三联疗法的组合和持续时间，以及（4）根除后确认的必要性。
胃肠病学家、内科医生和初级保健医生对这些建议的遵守情况存在显著差异。具体而言，94.1%的胃肠病学家和88.9%的内科医生认为尿素呼气试验是幽门螺杆菌诊断的首选测试，而初级保健医生中这一比例为60.0%。胃肠病学家与其他组在黏膜相关淋巴组织（MALT）淋巴瘤、胃癌患者的一级亲属、萎缩性胃炎、功能性消化不良以及同时使用非甾体抗炎药的根除指征方面存在显著差异。
初级保健医生可能不了解与胃恶性肿瘤风险或同时使用非甾体抗炎药相关的幽门螺杆菌诊断和根除的重要指征。公共卫生机构可能需要提高马斯特里赫特2000建议对初级保健医生的普及程度。
