Survey of current practices among members of CAG in the follow-up of patients diagnosed with gastric ulcer.
BACKGROUND
Guidelines recommend a policy of endoscopic follow-up of all gastric ulcers until healing. Analysis of data from the Alberta Endoscopy Project indicates that fewer than 50% of patients diagnosed with benign gastric ulcer had undergone a repeat procedure. The practice and attitudes of physician members of the Canadian Association of Gastroenterology (CAG) on the follow-up of such patients were assessed.


METHODS
A self-administered questionnaire was mailed to members of CAG. Respondents were asked to indicate their practice setting and to estimate the proportion of gastric ulcer patients in whom they perform follow-up endoscopy. They were also asked to indicate factors influencing this choice, including the role of Helicobacter pylori.


RESULTS
Fifty-seven per cent of 220 respondents indicated that they perform repeat endoscopy in 95% to 100% of individuals with benign gastric ulcer. The most common reasons influencing this choice were to ensure healing (86.3%) and to confirm the benign nature of the lesion (79.5%). Nonsteroidal anti-inflammatory drug (NSAID) use (83.2%) and patient ill health (62.9%) were the most common reasons for not repeating the endoscopy. Twenty per cent of individuals indicated that H pylori had influenced a change in their practice.


CONCLUSIONS
Physicians vary widely in their follow-up of benign gastric ulcer. Studies on the occurrence of gastric cancer in this setting are not unanimous in their conclusions. Subgroups of patients with NSAID exposure and successfully eradicated H pylori infection may have a lower risk of malignancy. Studies to confirm this are warranted, and modified guidelines may be appropriate.
Breslin
N P
NP
Department of Community Health Sciences, University of Calgary, Calgary, Canada.
Sutherland
L R
LR
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D003625:Data Collection; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D005762:Gastroenterology; D016481:Helicobacter Infections / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012955:Societies, Medical; D013276:Stomach Ulcer / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D011795:Surveys and Questionnaires
D000894:Anti-Inflammatory Agents, Non-Steroidal