A memorable patient: Early treatment of H pylori

BMJ 1997; 315 doi: (Published 19 July 1997) Cite this as: BMJ 1997;315:g
  1. Trefor Roscoe, general practitioner
  1. Sheffield

    Summarising yet another set of notes the other day, I came across a consultation from nearly 10 years ago that I easily recalled. At the time it had made an impact as I thought the patient most strange. Much later it had come back to me as I realised that he was right and I was wrong. I had not managed to remember who he was so could not confirm the details, until now.

    The patient was a man in his middle years who had come for his tablets. He had acne rosacea and was on intermittent six week courses of oxytetracycline. He needed them only two or three times a year to keep it at bay. As I was new to the practice and he did not come in often, I remember asking him if he was otherwise fit and well. He mentioned his occasional indigestion and then said something that struck me as quite odd. My note of the consultation reads “Repeat Rx Oxytet 100. Occ. Indigestion. Says oxytet cures it!” I had underlined the latter and added the exclamation mark as I was so surprised. I remember asking him to clarify which tablets he thought helped his indigestion and having it confirmed. He had not bothered to finish the course of cimetidine given by my colleague a few months before; they had not worked. At the time I thought him very strange. Antibiotics did not cure indigestion in 1987.

    A few years later, when the bug that was to be named Helicobacter pylori was discovered, I had cause to remember this consultation. One of the original recommendations for the treatment of H pylori was tetracyclines, and some regimens still suggest them. Resistance is now a problem but this patient had made an observation. If only I had realised that he was right and that I was wrong, I might have made the breakthrough. Oh well, that was obviously not to be my destiny. Had I told my colleagues of this “breakthrough” I would have been laughed at—H2 blockers were the mainstay of treatment then, not antibiotics.

    This man taught me several things. The simplest consultation can stick in your mind in great detail and come back years later, when its significance is realised. The patient may seem peculiar, but he may be telling you something that is revolutionary. We ignore such things that do not fit into the standard view at our peril.

    We welcome filler articles up to 600 words on topics such as A memorable patient, A paper that changed my practice, My most unfortunate mistake, or any piece conveying instruction, pathos, or humour. If possible the article should be supplied on a disk.

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