The Diagnosis and Therapy of Helicobacter pylori Infection in Hungary: Comparison of Strategies Applied by Family Physicians and Internists

Bernadett Márkus, L. Herszényi, Melinda Matyasovszky, Krisztián Vörös, Péter Torzsa, Imre Rurik, Z. Tulassay, L. Kalabay

Research output: Article

1 Citation (Scopus)

Abstract

Background Aims: Most patients with Helicobacter pylori infection are consulted for the first time by family physicians. We aimed to survey the adherence to the newest guidelines of the management of H. pylori infection in the primary and secondary care settings in Hungary. Methods: From a total of 793 physicians, 94 trainees in family medicine, 334 family physicians without and 195 with board certification in internal medicine, 87 internists, 78 family paediatricians were invited to take part in the study. Diagnostic and therapeutic attitudes towards H. pylori infection were compared by a voluntary and anonymous questionnaire. Results: Participants test for H. pylori infection in 92.8% of cases with a family history of peptic ulcer or 76.9% of gastric cancer, 68.9% of dyspepsia and 49.9% of non-specific abdominal complaints, before initiation of non-steroidal anti-inflammatory drug (NSAID; 17.3%) and antiplatelet treatment (14.5%), respectively. They confirm the success of eradication therapy in 88.1% mainly by urea breath test. Most of them initiate eradication therapy by themselves and only 22.4% refer their patients to a gastroenterologist. Clarithromycin-based standard triple therapy is the most preferred (62.1%) and only 3.7% choose quadruple combination with bismuth as first-line and 48.1% as second-line therapy. We found significant differences between groups with respect to the physicians' own infection, localization of practice, and sources of information on H. pylori infection. Internists are more likely to clarify H. pylori status before the initiation of NSAID and antiplatelet therapies, initiate second-line therapies and use bismuth compared to the other groups. Family physicians with board certification in internal medicine are also prone to start eradication therapy and less prone to refer patients to a gastroenterologist. Family paediatricians prefer stool antigen determination, screen family members and prefer gastroenterologist consultation more often, and use bismuth less frequently than the other groups. Family physicians with previous infection check for H. pyloriinfection more frequently before the initiation of NSAID treatment and are more likely to use histology to detect H. pylori. Postgraduate trainings were the most popular source of information. Conclusion: The adherence to the recent recommendations of current guidelines is moderate. There is a need to increase adherence to current recommendations by family physicians and internists.

Original languageEnglish
JournalDigestive Diseases
DOIs
Publication statusPublished - jan. 1 2019

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Hungary
Family Physicians
Helicobacter Infections
Helicobacter pylori
Bismuth
Non-Steroidal Anti-Inflammatory Agents
Therapeutics
Certification
Internal Medicine
Guidelines
Physicians
Secondary Care
Breath Tests
Clarithromycin
Dyspepsia
Infection
Peptic Ulcer
Stomach Neoplasms
Urea
Primary Health Care

ASJC Scopus subject areas

  • Gastroenterology

Cite this

The Diagnosis and Therapy of Helicobacter pylori Infection in Hungary : Comparison of Strategies Applied by Family Physicians and Internists. / Márkus, Bernadett; Herszényi, L.; Matyasovszky, Melinda; Vörös, Krisztián; Torzsa, Péter; Rurik, Imre; Tulassay, Z.; Kalabay, L.

In: Digestive Diseases, 01.01.2019.

Research output: Article

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abstract = "Background Aims: Most patients with Helicobacter pylori infection are consulted for the first time by family physicians. We aimed to survey the adherence to the newest guidelines of the management of H. pylori infection in the primary and secondary care settings in Hungary. Methods: From a total of 793 physicians, 94 trainees in family medicine, 334 family physicians without and 195 with board certification in internal medicine, 87 internists, 78 family paediatricians were invited to take part in the study. Diagnostic and therapeutic attitudes towards H. pylori infection were compared by a voluntary and anonymous questionnaire. Results: Participants test for H. pylori infection in 92.8{\%} of cases with a family history of peptic ulcer or 76.9{\%} of gastric cancer, 68.9{\%} of dyspepsia and 49.9{\%} of non-specific abdominal complaints, before initiation of non-steroidal anti-inflammatory drug (NSAID; 17.3{\%}) and antiplatelet treatment (14.5{\%}), respectively. They confirm the success of eradication therapy in 88.1{\%} mainly by urea breath test. Most of them initiate eradication therapy by themselves and only 22.4{\%} refer their patients to a gastroenterologist. Clarithromycin-based standard triple therapy is the most preferred (62.1{\%}) and only 3.7{\%} choose quadruple combination with bismuth as first-line and 48.1{\%} as second-line therapy. We found significant differences between groups with respect to the physicians' own infection, localization of practice, and sources of information on H. pylori infection. Internists are more likely to clarify H. pylori status before the initiation of NSAID and antiplatelet therapies, initiate second-line therapies and use bismuth compared to the other groups. Family physicians with board certification in internal medicine are also prone to start eradication therapy and less prone to refer patients to a gastroenterologist. Family paediatricians prefer stool antigen determination, screen family members and prefer gastroenterologist consultation more often, and use bismuth less frequently than the other groups. Family physicians with previous infection check for H. pyloriinfection more frequently before the initiation of NSAID treatment and are more likely to use histology to detect H. pylori. Postgraduate trainings were the most popular source of information. Conclusion: The adherence to the recent recommendations of current guidelines is moderate. There is a need to increase adherence to current recommendations by family physicians and internists.",
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AU - Matyasovszky, Melinda

AU - Vörös, Krisztián

AU - Torzsa, Péter

AU - Rurik, Imre

AU - Tulassay, Z.

AU - Kalabay, L.

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