Jearth Vaneet, Yadav Ashutosh Ishan, Shah Jimil, Singh Anupam Kumar, Sundaram Sridhar, Sharma Vishal, Dutta Usha, Makharia Govind, Panigrahi Manas Kumar
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
Department of Digestive Disease and Clinical Nutrition, Tata Memorial Hospital, Mumbai, 400 012, India.
Indian J Gastroenterol. 2025 Apr;44(2):208-219. doi: 10.1007/s12664-024-01694-z. Epub 2024 Oct 17.
Patients and primary care providers alike benefit greatly from the expertise of gastroenterologists when it comes to managing Helicobacter pylori (H. pylori) infection. However, information on gastroenterologists' practices in the management of H. pylori infection is scarce in this part of the world. This study aimed at evaluating the practice patterns of gastroenterologists and gastroenterology fellows in India.
This was a cross-sectional questionnaire-based survey of gastroenterologists and gastroenterology fellows working in India.
Total 207 gastroenterologists and 53 fellows filled out the questionnaire. Responses were received from all around India. Approximately 70% of respondents perceive H. pylori to be a gastric pathogen, while 20% regard it as a commensal bacterium. While the proportion of respondents who chose a test and treat method (34.6%) for uninvestigated dyspepsia without alarm symptoms was comparable to empirical proton pump inhibitor (PPI) therapy (38.8%), about one-fifth chose a scope and treat strategy in this setting. Even in the absence of alarm signs, more than half of respondents (61.5%) preferred endoscopic biopsy to detect H. pylori. While rapid urease testing (RUT) was the preferred modality (80%) for detecting H. pylori, about one-third preferred single-site RUT (from the antrum). Only 40% followed the Updated Sydney protocol, while performing biopsies and a majority (78.8%) are unable to discontinue PPIs before testing for H. pylori. PPI-clarithromycin-based triple treatment was the preferred regimen (67%) for first-line eradication, while nearly a quarter of respondents did not utilize bismuth due to concerns about adverse effects.
The survey reveals a lack of adherence to the current H. pylori guidelines for diagnosis, testing and treatment among gastroenterologists and gastroenterology fellows in India. It is vital that scientific societies simplify guidelines, investigate challenges to their effective implementation and execute targeted interventions to increase adherence.
在管理幽门螺杆菌（H. pylori）感染方面，患者和初级保健提供者都能从胃肠病学家的专业知识中受益匪浅。然而，在世界的这一地区，关于胃肠病学家管理幽门螺杆菌感染的实践信息却很匮乏。本研究旨在评估印度胃肠病学家和胃肠病学研究员的实践模式。
这是一项基于问卷调查的横断面研究，对象是在印度工作的胃肠病学家和胃肠病学研究员。
共有207名胃肠病学家和53名研究员填写了问卷。问卷回复来自印度各地。约70%的受访者认为幽门螺杆菌是胃部病原体，而20%将其视为共生菌。对于无报警症状的未经调查的消化不良患者，选择检测和治疗方法（34.6%）的受访者比例与经验性质子泵抑制剂（PPI）治疗（38.8%）相当，约五分之一的受访者在此情况下选择内镜检查和治疗策略。即使没有报警症状，超过一半的受访者（61.5%）仍倾向于通过内镜活检来检测幽门螺杆菌。虽然快速尿素酶试验（RUT）是检测幽门螺杆菌的首选方法（80%），但约三分之一的受访者倾向于单点RUT（取自胃窦）。只有40%的人遵循更新后的悉尼协议进行活检，并且大多数人（78.8%）在检测幽门螺杆菌之前无法停用PPI。基于PPI - 克拉霉素的三联疗法是一线根除的首选方案（67%），而近四分之一的受访者因担心不良反应而未使用铋剂。
该调查显示，印度的胃肠病学家和胃肠病学研究员在幽门螺杆菌诊断、检测和治疗方面缺乏对当前指南的遵循。科学协会简化指南、调查有效实施的挑战并执行有针对性的干预措施以提高遵循度至关重要。
