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17 ERADICATION OF HELICOBACTOR PYLORI IN YOUNG PATIENTS WITH UNINVESTIGATED DYSPEPSIA LEADS TO A REDUCTION IN THE REQUIREMENT OF ACID SUPPRESSIVE THERAPY WP Pais, H Singh, LE Targownik BACKGROUND: There is a continuing debate on the proper management of patients presenting with dyspepsia without alarm symptoms. While some advocate initial management with acid suppressive medications (ASMs) including proton pump inhibitors (PPIs) or H2-blockers, they are only effective in a small proportion of patients with uninvestigated dyspepsia, and long-term treatment is often required at considerable expense. Others recommend first testing for Helicobacter pylori (HP) and treating it if positive. While treating HP in uninvestigated dyspepsia is also of limited efficacy, it is a self-limited treatment which may limit the chronic use of ASMs. Our goal was to determine whether HP eradication leads to a reduction in the use of ASMs for young patients with uninvestigated dyspepsia.
Section of Gastroenterology, University of Manitoba, Winnipeg, Manitoba
METHODS: We reviewed medical records of Medicaid patients with less than 50 years age, three or more office visits with dyspepsia (identified by ICD-9 codes) and with greater than eight weeks of ongoing therapy with a PPIs or a H2 blockers in a suburban US practice in Georgia were evaluated. Ongoing use of PPIs or H2 blockers was ascertained from the medical records. Data was abstracted regarding testing and treatment of HP, and the subsequent use of ASMs over the subsequent six months of follow-up. The prevalence of continued ASMs use was compared between HP+ patients, HP- patients, and those who were not tested for HP.
RESULTS: We identified 361 patients (160 male and 201 female) with a mean age of 42 years who met the study criteria. Of the 247 patients who were tested for HP, 157 (63%) tested positive, of whom 135 (86%) were appropriately treated, 70% of treated HP+ patients were able to discontinue use of ASMs, compared with 18% of untreated HP+. Treated HP+ patients who also significantly more likely to discontinue use of ASMs than untested patients, (70% vs 39%, P<0.001), or those found to be HP- (70% vs 57%, P=0.05).
CONCLUSIONS: Testing and treating for HP among young patients with uninvestigated dyspepsia leads to higher rates of discontinuation of ASMs as compared with those who are not tested or treated. Testing and treating for HP should be considered in all young patients with uninvestigated dyspepsia treated chronically with ASMs.