| Summary: | There appears to be a disconnect between current guidelines for
Helicobacter pylori testing and treatment, and clinical practice, including
physician beliefs and actual prescribing patterns. In particular, there are
markedly different approaches in primary and secondary care, and country-
specific differences in eradication therapy for H pylori infection.
Although most physicians do not believe that H pylori causes nonulcer
dyspepsia, the majority appear to prescribe eradication. Less information
is available on the management of H pylori infection and gastroesophageal
reflux disease, and more marked differences in attitudes and
practice occur in this condition. Even in peptic ulcer disease, where most
clinicians both in primary and in secondary care believe H pylori should
be eradicated, there is often a breakdown in the translation of this belief
into practice. There is also confusion in terms of treatment regimens
applied for H pylori eradication. Eradication regimens are less successful
in practice than in clinical trials. Furthermore, a sizable proportion of
patients with peptic ulcer remain symptomatic despite cure of the ulcer
diathesis, which may undermine confidence. Therapeutic confusion
about what to prescribe, side effects limiting compliance, bacterial resistance,
and socioeconomic factors may all impair therapeutic success with
eradication therapy in practice. Unfortunately, it has been well documented
that guidelines alone are likely to have little or no impact in practice.
Publication in a journal is unlikely to lead to effective
implementation in primary care. On the basis of available evidence, clinical
behaviour is most likely changed when guidelines are developed by
the peer group of clinicians for whom they were intended, are disseminated
through a specific educational program, and are implemented by applying,
preferably during the consultation, specific reminders.
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