A National Survey of Primary Care Physicians??? Perceptions and Practices Related to Helicobacter pylori Infection

OBJECTIVE: Our aim was to assess current perceptions and practices of primary care physicians in the United States concerning Helicobacter pylori infection. METHODS: We mailed a structured questionnaire to approximately 2500 primary care physicians chosen at random from a national database. We asked about personal and practice demographics and practices relating to testing for and treating H. pylori infection. RESULTS: We received 424 responses from 2349 questionnaires (18%). Only 3% each had used either the C- or C-urea breath test; 5% had used the stool antigen test; 92% and 91% recommended testing-and 90% and 82% treatment-for H. pylori in patients with active duodenal and gastric ulcer, respectively. However, only 64% would test for and only 59% would treat H. pylori infection in a patient with past history of duodenal ulcer. Almost half would test patients with gastroesophageal reflux disease being started or maintained on a proton pump inhibitor. The most frequent treatment regimens used were combinations of a proton pump inhibitor, clarithromycin, and either amoxicillin or metronidazole. Most respondents had inaccurate information on antibiotic resistance rates for H. pylori. In the absence of symptoms, 26% would personally undergo testing for H. pylori; 30% would be treated if infected. CONCLUSIONS: Primary care physicians usually test for and treat H. pylori infection in patients with active ulcer, but fail to do so in patients with a prior history of ulcer. Some test for H. pylori in gastroesophageal reflux disease patients. Most use efficacious treatment regimens, but have inaccurate information on resistance rates.