Gastro-protective strategies in primary care in Italy: the "Gas.Pro." survey.
BACKGROUND
Risk of gastrointestinal injury is relevant among users of anti-inflammatory or cardio-protective drugs. Adequate gastro-protection is warranted in high-risk patients.


OBJECTIVE
To assess the perceptions and practices of Italian primary care physicians regarding gastro-protective strategies.


METHODS
Nationwide cross-sectional observational study. A 14-question survey questionnaire was administered to 112 primary care physicians throughout Italy. Data collection covered consecutive outpatient candidates for the prescription of a potentially GI harmful medication, observed in the physicians' office over a 3-week period.


RESULTS
Cohort included 3943 cases (2489 naïve and 1463 chronic NSAID/ASA users). Mean age and prevalence of cardiovascular comorbidity were significantly higher in the latter subgroup. Non-selective NSAIDs and low-dose aspirin were the most commonly prescribed drugs. Combined NSAIDS/ASA plus steroids/anticoagulant/antiplatelets were recorded in 161 cases. Helicobacter pylori status was known in only 38% of naïve and 33.2% of chronic users, being negative in 85.3% and 89.5%, respectively. When positive, H. pylori was eradicated by almost all physicians (97.9%), but in case of unknown H. pylori status, the presence of infection was investigated in only 8.6% and 14.9% of patients in the two subgroups. Gastro-protection was endorsed in 80.7% of patients, mostly PPIs (91%). In patients aged over 70, pantoprazole and lansoprazole were the preferred gastro-protective agents.


CONCLUSIONS
There is a significant over-use of gastro-protection in the primary care setting in Italy and the role H. pylori is largely overlooked. Educational efforts should be directed to a more targeted gastro-protection only for at-risk patients as well as improved adherence to recommendations for testing and treating H. pylori infection.
Bianco
Maria A
MA
U.O.C. di Gastroenterologia - Ospedale Maresca, Torre del Greco, Viale degli Aranci 2, 80131 Naples, Italy. ivmbi@tin.it
Rotondano
Gianluca
G
Buri
Luigi
L
Tessari
Francesco
F
Cipolletta
Livio
L
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000382:microbiology / Q000517:prevention & control*; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis*; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family; D010818:Practice Patterns, Physicians'; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D054328:Proton Pump Inhibitors