Howden Colin W, Spechler Stuart J, Vaezi Michael F, Fendrick A Mark, Atkinson Christian, Pelletier Corey, Jacob Rinu, Brunton Stephen
University of Tennessee Health Science Center, Memphis, TN.
Department of Medicine, Baylor University Medical Center and Center for Esophageal Research, Baylor Scott & White Research Institute, Dallas, TX.
Gastro Hep Adv. 2022 Feb 3;1(2):231-240. doi: 10.1016/j.gastha.2021.12.005. eCollection 2022.
eradication rates have declined as antibiotic resistance rates have increased. In addition, adherence to treatment guidelines is suboptimal. It is therefore important that contemporary, real-world evidence of diagnostic and treatment patterns is explored and compared with evidence-based guidelines. The Study of Acid-Related Disorders investigated unmet needs among patients with infection and past or current dyspepsia.
Gastroenterologists (GIs) and family physicians (FPs) or general practitioners (GPs) treating patients with infection and past or current dyspepsia completed a physician survey and invited patients to complete a patient survey; data were also extracted from the medical records of enrolled patients.
Two hundred fifty-one physicians and 77 patients were enrolled. A total of 19.5% of patients were diagnosed by serology, whereas the urea breath test was used by 6.5% of GIs and 50.0% of FPs or GPs. A total of 68.6% of GIs and 79.8% of FPs or GPs selected clarithromycin, amoxicillin, and proton pump inhibitor triple therapy as their ideal first-line treatment. Physicians reported that 52.9% of patients experienced dyspepsia daily. A total of 46.8% of patients believed that complete resolution of dyspepsia would indicate effective treatment. As their treatment goal, 69.3% of physicians selected improvement in overall symptoms, whereas 92.2% of patients specified improvement in dyspepsia. Only 28.7% of physicians were satisfied with current treatment options. A total of 59.7% of patients took all of their prescribed medicine(s). A total of 59.7% of patients would prefer to take fewer pills; 45.5% would prefer convenience packs.
This study reveals a lack of adherence to current guidelines for diagnosis, testing, and treatment. New treatment options that are more efficacious and simpler for patients to adhere to are needed.
随着抗生素耐药率上升，根除率有所下降。此外，对治疗指南的依从性也不理想。因此，探索当代现实世界中诊断和治疗模式的证据并与循证指南进行比较很重要。酸相关疾病研究调查了幽门螺杆菌感染以及既往或当前患有消化不良患者中未满足的需求。
治疗幽门螺杆菌感染以及既往或当前患有消化不良患者的胃肠病学家（GI）和家庭医生（FP）或全科医生（GP）完成了一份医生调查问卷，并邀请患者完成一份患者调查问卷；数据还从入组患者的病历中提取。
共招募了251名医生和77名患者。共有19.5%的患者通过血清学诊断，而6.5%的胃肠病学家和50.0%的家庭医生或全科医生使用尿素呼气试验。共有68.6%的胃肠病学家和79.8%的家庭医生或全科医生选择克拉霉素、阿莫西林和质子泵抑制剂三联疗法作为他们理想的一线治疗方案。医生报告称，52.9%的患者每天都有消化不良症状。共有46.8%的患者认为消化不良完全缓解表明治疗有效。作为治疗目标，69.3%的医生选择改善总体症状，而92.2%的患者指定改善消化不良症状。只有28.7%的医生对当前的治疗方案满意。共有59.7%的患者服用了所有开的药。共有59.7%的患者希望服用更少的药片；45.5%的患者更喜欢便捷包装。
本研究揭示了对当前幽门螺杆菌诊断、检测和治疗指南缺乏依从性。需要更有效且患者更易依从的新治疗方案。
