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119 TREATMENT OF HELICOBACTER PYLORI IN INPATIENTS AND OUTPATIENTS IN A TERTIARY CARE CENTRE J Nazareno, D Driman, P Adams BACKGROUND: Helicobacter pylori is associated with peptic ulcer disease and gastric cancer. Although effective treatment is available recent studies show that it is not often considered and not well managed. This study examines the treatment of all H pylori diagnosed by gastric biopsy in London, Ontario including a comparison of treatment in inpatients and outpatients.
University of Western Ontario, London, Ontario
METHODS: All gastric pathology reports in the pathology database of London Health Sciences Centre between January 1, 2004 and December 31, 2004 were searched. Reports in which H pylori was present were noted. Hospital charts, inpatients order sheets, dictations and discharge summaries were reviewed in these patients. Office charts, clinic notes and endoscopy reports were also reviewed.
RESULTS: One hundred ninety-three patients were diagnosed with H pylori by gastric biopsy in 2004. This included 143 (74%) outpatients and 50 (26%) inpatients. Overall, there was a similar number of males (51%) and females (49%). The average age was 59 years. The most common reasons for doing endoscopy were dyspepsia (37%), gastrointestinal bleed (20%), gasttroesophageal reflux (16%), anemia (11%) and a radiological abnormality (4%). The most common endoscopy results were erythema (40%), peptic ulcer disease (27%), a normal endoscopy (21%) and nodularity (6%). Gastritis, intestinal metaplasia, carcinoma and lymphoma were present in 84%, 14%, 1% and 0.5%, respectively.
Overall, 84% of patients were treated with H pylori eradication. Ninety-two per cent of the outpatients were treated. However, only 60% of the inpatients received treatment. The average length of stay for inpatients was 8.4 days. Among the inpatients in whom H pylori was present, the pathology report was available in only 40% of the cases before the patient was discharged from hospital. Empiric treatment without the availability of H pylori status occurred in almost half (47%) of the inpatients. There was no significant difference in treatment whether the patient was admitted to a medical (57%) or nonmedical service (62%).
CONCLUSION: H pylori diagnosed as an inpatient is treated poorly compared with outpatients. In the majority of cases the patients are discharged home before the pathology report is available. More rapid reporting or more careful followup of pathology reports is needed.