227 MANAGEMENT OF PEPTIC ULCER DISEASE IN PRIMARY CARE

A.J. Morris, C. Craig, C. Morran, H. Burns, A. Power, K. Harden, D. Walsh, R. C. Stuart.ACID 1 Study group, Digestive Disease Directorate, Glasgow Royal Infirmary, Glasgow, UK

Aim: Eradication of H. pylori infection in patients with peptic ulcer disease patients reduces the need for long term acid suppression therapy and the risk of complications such as bleeding and perforation yet patients with this diagnosis continue to be treated with acid suppression therapy in primary care. We aimed to assess the extent to which these patients had been investigated for H. pylori infection and identify a population who might benefit from H. pylori testing and eradication.

Methods: From 11,149 patients who had received acid suppression in the preceding year (Total GP population 176,268) we undertook case note review and identified 3071 (27.5%) patients who had previously diagnosed peptic ulcer disease (77.2% DU, 13.1% GU, 6.1% both, 3.5% unspecified ulcer type). 2063 patients were receiving maintenance therapy (Defined as ≥ 3 prescriptions/year). Of these, 1275 who had no contraindication to H. pylori eradication were invited to nurse led clinics for H. pylori testing: 705 attended and underwent 13C urea breath testing to establish H. pylori status.

Results: Only 36.4% of patients identified with known peptic ulcer disease had previously received eradication therapy. 26.9% were taking NSAIDs concomitantly (53.6% aspirin, 37.7% other NSAIDs and 8.7% both). H. pylori prevalence was 65.6% in patients who had never had documented eradication therapy and, although lower if patients had prior eradication therapy. 23.0% of previously treated ulcer patients remained infected at the time of testing.

Conclusions: A substantial proportion of ulcer patients receiving acid suppression therapy in general practice have never received H. pylori eradication and almost a quarter of those previously treated remain infected with the organism. There is considerable potential for improvement …