title: How well is Helicobacter pylori treated in usual practice?
abstract: BACKGROUND
  Helicobacter pylori is a WHO class I carcinogen also associated with nonmalignant gastrointestinal diseases. Effective treatment exists, and all persons infected with H pylori should receive treatment. However, data regarding the rates of treatment prescription in clinical practice are lacking.
  
  
  OBJECTIVE
  To determine the rates of H pylori treatment in usual practice.
  
  
  METHODS
  Patients with histological evidence of H pylori infection between January 1, 2007, and December 31, 2007, at Sunnybrook Health Sciences Centre (Toronto, Ontario) were identified. Charts were reviewed to determine the rates of H pylori treatment and confirmation of eradication, when indicated. Questionnaires were subsequently sent to endoscopists of patients identified as not having received treatment to determine the reasons for lack of treatment.
  
  
  RESULTS
  A total of 102 patients were H pylori positive and were appropriate candidates for treatment, of whom 58 (57%) were male and 78 (76%) were outpatients, with 92 (90%) receiving eradication therapy. When indicated, 15 of 22 (68%) patients received confirmation of eradication, 13 of 18 (72%) patients underwent repeat endoscopy and 86% received complete therapy. Outpatients were more likely to receive eradication therapy (OR 10.3 [95% CI 2.6 to 40.4]; P=0.001) and complete therapy (OR 13.2 [95% CI 3.8 to 45.7]; P=0.0001) compared with inpatients. Having a follow-up appointment resulted in higher treatment rates (OR 12.0 [95% CI 3.0 to 47.5]; P=0.001).
  
  
  CONCLUSIONS
  During the time period studied, adequate rates of H pylori treatment were achieved in outpatients and patients who had formal follow-up at Sunnybrook Health Sciences Centre. However, some aspects of care remain suboptimal including treatment of inpatients and care following treatment. Additional studies are required to identify strategies to improve the care of patients infected with H pylori.
authors: Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada.
authors: Kumaresan
authors: K
authors: Yogeswaran
authors: Grant
authors: G
authors: Chen
authors: Lawrence
authors: L
authors: Cohen
authors: Mary Anne
authors: MA
authors: Cooper
authors: Elaine
authors: E
authors: Yong
authors: Eugene
authors: E
authors: Hsieh
authors: Corwyn
authors: C
authors: Rowsell
authors: Fred
authors: F
authors: Saibil
authors: Jill
authors: J
authors: Tinmouth
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000592:standards; D016099:Endoscopy, Gastrointestinal; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards*