Bennett K et al. (2006) Impact of Helicobacter pylori on the management of dyspepsia in primary care. Aliment Pharmacol Ther 24: 637–641

The discovery of Helicobacter pylori changed our understanding of dyspepsia and its treatment. For instance, if H. pylori infection is present, eradication triple therapy is preferable to antisecretory therapy. In a new, retrospective study, Bennett et al. investigated whether H. pylori infection has any impact on primary-care decisions relating to dyspepsia treatment in Ireland, and to what extent the published treatment guidelines are followed. Although treatment guidelines are available to Irish physicians, they have not been formally distributed.

The results of 13C urea breath tests (UBTs) of 805 dyspeptic patients, and data on the patients' subsequent prescriptions, were gathered from two databases. Overall, 374 patients had a positive UBT: 60.4% of these were prescribed eradication triple therapy (as recommended in the guidelines), 24.6% were prescribed nothing at all, and the remaining 15% were prescribed either dual therapy, antimicrobial monotherapy or antisecretory therapy. Less than half (43%) of the patients prescribed triple therapy underwent the recommended posteradication UBT. Of the 431 patients with a negative UBT, 7% were prescribed triple or dual therapy (against the guidelines).

In the year after UBT, prescription of antisecretory therapy was less common; although the decline was greatest for patients with a positive UBT, there was also a decline for patients with a negative UBT. The reasons for this finding are unknown. Bennett et al. suggest that active promotion of the existing guidelines would improve the first-line management of dyspepsia.