U.O.C. di Gastroenterologia - Ospedale Maresca, Torre del Greco, Viale degli Aranci 2, 80131 Naples, Italy.
Dig Liver Dis. 2010 May;42(5):359-64. doi: 10.1016/j.dld.2009.11.003. Epub 2009 Dec 11.
Risk of gastrointestinal injury is relevant among users of anti-inflammatory or cardio-protective drugs. Adequate gastro-protection is warranted in high-risk patients.
To assess the perceptions and practices of Italian primary care physicians regarding gastro-protective strategies.
Nationwide cross-sectional observational study. A 14-question survey questionnaire was administered to 112 primary care physicians throughout Italy. Data collection covered consecutive outpatient candidates for the prescription of a potentially GI harmful medication, observed in the physicians' office over a 3-week period.
Cohort included 3943 cases (2489 naïve and 1463 chronic NSAID/ASA users). Mean age and prevalence of cardiovascular comorbidity were significantly higher in the latter subgroup. Non-selective NSAIDs and low-dose aspirin were the most commonly prescribed drugs. Combined NSAIDS/ASA plus steroids/anticoagulant/antiplatelets were recorded in 161 cases. Helicobacter pylori status was known in only 38% of naïve and 33.2% of chronic users, being negative in 85.3% and 89.5%, respectively. When positive, H. pylori was eradicated by almost all physicians (97.9%), but in case of unknown H. pylori status, the presence of infection was investigated in only 8.6% and 14.9% of patients in the two subgroups. Gastro-protection was endorsed in 80.7% of patients, mostly PPIs (91%). In patients aged over 70, pantoprazole and lansoprazole were the preferred gastro-protective agents.
There is a significant over-use of gastro-protection in the primary care setting in Italy and the role H. pylori is largely overlooked. Educational efforts should be directed to a more targeted gastro-protection only for at-risk patients as well as improved adherence to recommendations for testing and treating H. pylori infection.
抗炎或心脏保护药物的使用者存在胃肠道损伤的风险。高危患者需要充分的胃保护。
评估意大利初级保健医生对胃保护策略的认知和实践。
全国性横断面观察性研究。向意大利各地的 112 名初级保健医生发放了一份包含 14 个问题的调查问卷。数据收集涵盖了连续门诊患者中可能对胃肠道有害的药物处方，在医生办公室观察了 3 周。
队列纳入了 3943 例患者（2489 例初治患者和 1463 例慢性 NSAID/ASA 使用者）。后者亚组的平均年龄和心血管合并症的患病率明显较高。非选择性 NSAIDs 和低剂量阿司匹林是最常开的药物。记录了 161 例联合 NSAIDs/ASA 加类固醇/抗凝剂/抗血小板药物。初治患者中仅 38%和慢性患者中仅 33.2%的患者知道 H. pylori 状态，分别有 85.3%和 89.5%的患者为阴性。当 H. pylori 为阳性时，几乎所有医生都进行了根除治疗（97.9%），但在未知 H. pylori 状态的情况下，只有 8.6%和 14.9%的患者在两个亚组中进行了感染调查。80.7%的患者接受了胃保护治疗，主要是 PPI（91%）。在年龄超过 70 岁的患者中，泮托拉唑和兰索拉唑是首选的胃保护药物。
意大利初级保健中存在显著的过度使用胃保护药物的情况，而且 H. pylori 的作用在很大程度上被忽视。教育工作应针对高危患者进行有针对性的胃保护，同时提高对 H. pylori 感染检测和治疗建议的依从性。
