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CLINICA CAYANGA |
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Eradicate HP in patients with history of PUD |
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Clinical Question: Should patients with a history of peptic ulcer undergo empiric therapy to eradicate H pylori? Bottom Line: Ulcer-related outcomes of asymptomatic patients receiving maintenance antisecretory agents for peptic ulcer disease can be improved with immediate H. pylori eradication at reduced cost. Therefore, H. pylori eradication should be aggressively pursued in all patients-symptomatic or not-with previously documented peptic ulcers, who are receiving maintenance antisecretory therapy.If symptoms persist, a breath test can confirm eradication; if treatment failed, a second course of eradication can be attempted.If they are H pylori negative but still symptomatic, they probably have non−ulcer dyspepsia, although gastric cancer should be considered in patients over age 55 or those with worrisome symptoms for malignancy. Reference: Fendrick AM, McCort JT, Chernew ME, et al. Immediate eradication of Helicobacter pylori in paients with previouslydocumented peptic ulcer disease: clinical and economic effects. Am J Gastro 1997; 92: 2017−23. Study Design: Cost−effectiveness analysis Synopsis: The clinical and economic benefits of Helicobacter pylori eradication for patients with newly diagnosed peptic ulcer disease are widely accepted. The objective of this study was to estimate the cost-effectiveness of H. pylori eradication in the large cohort of asymptomatic patients receiving maintenance antisecretory therapy for a previously documented peptic ulcer disease. The authors did a decision analytic model estimated the clinical and economic effects of two management strategies for asymptomatic patients receiving maintenance antisecretory therapy for a previously documented peptic ulcer: strategy 1-immediate H. pylori eradication therapy and cessation of maintenance therapy, and strategy 2-continued-maintenance antisecretory therapy, with H. pylori eradication therapy reserved for the first symptom recurrence. At 1 yr, the model estimated that immediate H. pylori eradication therapy (strategy 1) led to 22% fewer months with ulcers (28.7 vs. 36.8 ulcer months/100 patient years), 10% fewer months with ulcer symptoms (21.0 vs. 23.1 symptom months/100 patient years), and 24% lower per-patient expenditures ($587 vs. $767/patient year) than maintenance antisecretory therapy and symptom-based H. pylori eradication (strategy 2). Immediate H. pylori eradication, however, resulted in 14% more months with upper gastrointestinal symptoms from all causes (37.9 vs. 33.2 symptom months/100 patient years) than strategy 2, because maintenance antisecretory therapy was effective in treating symptoms due to causes other than peptic ulcer disease. |
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