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Attitudes and practice related to Helicobacter pylori infection among primary care physicians

Boltin, Doron; Kimchi, Nimrod; Dickman, Ram; Gingold-Belfer, Rachel; Niv, Yaron; Birkenfeld, Shlomo

European Journal of Gastroenterology & Hepatology: September 2016 - Volume 28 - Issue 9 - p 1035–1040
doi: 10.1097/MEG.0000000000000659
Original Articles: Upper Gastrointestinal Disorders

Objectives Helicobacter pylori infection is a major public health concern and primary care physicians (PCPs) are at the forefront of H. pylori management. We aimed to assess PCP attitudes related to H. pylori and identify areas where PCP practice deviates from the accepted guidelines.

Methods A 13-item multiple-choice internet-based questionnaire was distributed to PCPs on a national level. Five questions were related to H. pylori detection, two were related to treatment, three were related to gastric cancer, and three were related to screening. The Maastricht IV/Florence Consensus Report was used as the benchmark for correct responses.

Results A total of 314 PCP responses were included [140 (52%) men, age 48.2±12.9 years]. Of the total, 292 (93.0%) prescribed clarithromycin-based triple therapy for first-line treatment, 95 (30.3%) prescribed levofloxacin or bismuth-based protocols for second-line treatment, and 137 (43.6%) routinely confirmed eradication. Screening relatives of gastric cancer patients and screening before NSAID treatment was reported by 87 (30.9%) and 39 (14.1%) PCPs, respectively. Of all, 130 (45.0%) believed that the organism is definitely carcinogenic and only 188 (65.0%) agreed that H. pylori eradication reduces the risk of developing gastric cancer. Adherence with guidelines was associated with younger age, central urban clinic location, and a high volume of H. pylori patients.

Conclusion Overall PCP adherence to H. pylori management guidelines is low. Public health agencies should advance educational initiatives aimed at closing these gaps.

Supplemental Digital Content is available in the text.

aDepartment of Gastroenterology, Rabin Medical Center, Petah Tikva

bSackler Faculty of Medicine, Tel Aviv University

cTel Aviv and Central Administration, Clalit Health Services, Tel Aviv

dBat Yamon Medical Center, Clalit Health Services, Bat Yam, Israel

Correspondence to Doron Boltin, MBBS, Rabin Medical Center, Division of Gastroenterology, 39 Jabotinski Street, Petah Tikva 49100, Israel Tel: +972 3 9377236; fax: +972 3 9210313; e-mail:

Received February 25, 2016

Accepted April 5, 2016

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.