Abstract
Objetivo
Analizar el manejo de la dispepsia, la úlcera péptica y la infección por Helicobacter pylori (Hp) en atención primaria.
Diseño
Estudio observacional, transversal, realizado mediante cuestionario anónimo entre enero y octubre de 2000.
Emplazamiento
Atención primaria.
Participantes
Médicos de 17 centros de atención primaria (CAP).
Mediciones
Encuesta de 19 preguntas remitida por correo.
Resultados principales
Respondieron un 64,8% de los médicos (107/165). El 94,3% había realizado uno o más tratamientos erradicadores en el último año. El 89,7% indica erradicación de forma habitual en la úlcera duodenal y el 70,1% en la úlcera gástrica. El 79,4% no ha indicado nunca tratamiento erradicador sin documentar la infección por Hp. La endoscopia asociada a histología y/o ureasa es la técnica más utilizada para el diagnóstico. La pauta terapéutica más utilizada (77,6%) es omeprazol, claritromicina y amoxicilina durante 7 días, cada 12 h. El 44,9% comprueba siempre la erradicación después del tratamiento, mientras que el 36,4% sólo lo hace si recidiva la sintomatología. El test del aliento (72,7%) es la prueba más utilizada para comprobar la erradicación. No se observaron diferencias en las respuestas en función de la antigüedad ni la titularidad de la plaza. Por el contrario, los especialistas en medicina familiar y comunitaria (MFyC) remiten menos a menudo pacientes al digestólogo, utilizan menos el tránsito gastroesofágico, utilizan más el test del aliento y realizan más tratamientos en duodenitis erosiva en comparación con el resto de facultativos de atención primaria.
Conclusiones
Las actitudes observadas se adecuan razonablemente a lo establecido en las reuniones de consenso y varían entre los médicos MFyC y el resto de facultativos de atención primaria.
Palabras clave: H, pylori, Dispepsia, Atención primaria
Abstract
Objective
To evaluate management of dyspepsia, gastroduodenal ulcer and Helicobacter pylori infection in the setting of family practice.
Design
An observational transversal study was performed. An anonymous questionnaire was send by mail between January and October 2000.
Setting
Primary care.
Participants
Physicians of 17 Primary Care centers.
Results
Sixty-four per cent of the physicians returned the answered questionnaire (107/165). Primary care doctors reported they had indicated eradication therapy at least once during last year in 94.3%; 89.7% usually indicate H. pylori eradication for duodenal ulcer and 70.1% for gastric ulcer. The main method for the study of dyspepsia was endoscopy associated with antral histology or rapid urease test for determination of H. pylori status. Omeprazole, clarithromycin and amoxicillin twice daily for seven days was the preferred eradication therapy (77.6%). Forty-five percent of physicians systematically tested patients to confirm cure of the infection; 36.4% tested patients only if symptoms relapsed. Breath test (72.7%) was the preferred method to confirm eradication. Physicians with postgraduate speciality in Family Care and Community Medicine (MFyC) demand less often gastroenterologist evaluation, indicate less frequently upper tract radiology, use more often C13 urea breath test for diagnosis and indicate more often eradication treatment for erosive duodenitis than unspecialised family doctors.
Conclusions
Management of dyspepsia and H. pylori infection in Primary Care in our area is reasonably adapted to current consensus recommendations. Many differences in management were observed between MFyC and non-specialised primary care physicians.
Key words: Helicobacter pylori, Dyspepsia, Primary Care
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