Practice patterns for managing Helicobacter pylori infection and upper gastrointestinal symptoms

Colin Howden, Steven W. Blume, Gregory De Lissovoy

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective: To assess adherence with guidelines for testing and treatment of Helicobacter pylori infection and upper gastrointestinal symptoms. Study Design: Retrospective longitudinal cohort analysis of patient-level medical and pharmacy claims from 75 US managed care plans. Methods: Persons with new claims for antisecretory medication, H pylori tests, or endoscopies were selected from among 2 million plan members continuously enrolled from 2001 to 2004 and were grouped by initial clinical diagnosis (3456 with peptic ulcer disease [PUD], 14 593 with nonulcer dyspepsia [NUD], and 36 233 with gastroesophageal reflux disease [GERD]). Diagnostic procedures, medications received, and sequencing of specific procedures and medications were examined relative to published guidelines by initial diagnosis, age, and physician specialty. Results: While guidelines recommend testing before treatment, one third of persons receiving antibiotics for H pylori infection had not first been tested for the infection. In one third of all posttreatment testing, primary care practitioners incorrectly used serologic tests, despite their inability to distinguish cured from active infection. Eighteen percent of patients with GERD were tested for H pylori, although there is no causal link between them. Only two thirds of patients aged 50 to 64 years with presumed PUD underwent endoscopy, which guidelines recommend for older adults; yet one third of patients with PUD aged 18 to 49 years, for whom prompt endoscopy is generally not recommended, had an endoscopy within 30 days of their index date. Conclusions: Substantial noncompliance with widely disseminated guidelines calls for better understanding of appropriate indications for H pylori testing and endoscopy to improve patient care and conserve healthcare resources.

Original languageEnglish (US)
Pages (from-to)37-44
Number of pages8
JournalAmerican Journal of Managed Care
Volume13
Issue number1
StatePublished - Jan 1 2007

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Helicobacter Infections
Helicobacter pylori
Endoscopy
Pylorus
Peptic Ulcer
Guidelines
Gastroesophageal Reflux
Infection
Guideline Adherence
Dyspepsia
Managed Care Programs
Serologic Tests
Primary Health Care
Patient Care
Cohort Studies
Retrospective Studies
Anti-Bacterial Agents
Delivery of Health Care
Physicians
Therapeutics

All Science Journal Classification (ASJC) codes

  • Health Policy

Cite this

Practice patterns for managing Helicobacter pylori infection and upper gastrointestinal symptoms. / Howden, Colin; Blume, Steven W.; De Lissovoy, Gregory.

In: American Journal of Managed Care, Vol. 13, No. 1, 01.01.2007, p. 37-44.

Research output: Contribution to journalArticle

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