Management of dyspepsia in primary care

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7141.1388 (Published 02 May 1998) Cite this as: BMJ 1998;316:1388

GPs are already choosing eradication therapy over endoscopy

  1. Remy Boutet, Senior registrar in public health medicine
  1. Cornwall and Isles of Scilly Health Authority, St Austell PL25 4NQ
  2. Department of Hepatogastroenterology, Hopital de l'Archet II, 06202 Nice Cedex, France
  3. Department of Internal Medicine and Gastroenterology, University of Bologna, 9-40138 Bologna, Italy
  4. Porretta Terme, Bologna, Italy
  5. University of Nottingham, Nottingham NG7 2UH
  6. Derbyshire Royal Infirmary, Southern Derbyshire Acute Hospitals NHS Trust, Derby DE1 2QY

    EDITOR—Agréus and Talley's recommendations for the use of Helicobacter pylori testing in the management of patients with newly appeared dyspepsia1 differ from published guidelines. 2 3 They consider eradication therapy an acceptable alternative to endoscopy for patients with a positive test result when access to this investigation is difficult. This alternative option is probably a fait accompli in primary care.

    In June 1995 I sent a questionnaire to all 298 general practitioners in north and east Devon asking how they would use H pylori testing for the management of patients with dyspepsia. After a reminder questionnaire, 271 general practitioners (91%) responded. The table shows the results.

    View this table:

    General practitioners' response to questionnaire on how they would use H pylori testing

    Only 73 (27%) said they would limit the use of this test to younger patients (under 50 years of age) as recommended by published guidelines at the time.2 Eighty five did not know when to use the test but many of these said how they would manage patients with a positive result. Most general practitioners (73%) would use eradication therapy rather than endoscopy in younger patients with a positive test result. Seventy eight (29%) said they would also attempt eradication therapy in older patients.

    At the time of the survey patients referred for endoscopy had to be placed on a waiting list. General practitioners might …

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