The Pages section of GPnotebook comprises more than 30,000 concise, interlinked clinical reference articles, each focused on a specific primary care topic.
amyloid-targeting immunotherapies in Alzheimer's disease
NICE guidance - people with early onset type 2 diabetes (diabetes that has been diagnosed before the age of 40)
Hereditary haemorrhagic telangiectasia
Iron deficiency without anaemia
Vibegron for overactive bladder
Recently, as I completed the final sections of my professional development plan for my CPD portfolio, I found it interesting to see the progress I had made with the topics I aimed to improve and learn more about.
For my audit topic this year, I focused on deprescribing proton pump inhibitors (PPIs). As a follow-up, I was curious to see some newly updated GPnotebook pages about Helicobacter pylori, which is a common factor in conditions that may be treated with PPIs. These drugs are often prescribed for ailments such as gastritis and peptic ulcer disease – conditions that can result from various causes, including NSAIDs, alcohol, stress and H. pylori infection.
This month’s column looks at a fascinating study on the relationship between H. pylori and gastric cancer, the GPnotebook page on which can be found here. The page describes two recent pieces of research in the area.
The first is a community-based randomised controlled trial that was conducted in China. The study involved people who tested positive for H. pylori using a 13C-urea breath test. They were randomly assigned to receive either a 10-day quadruple anti-H. pylori treatment (including 20 mg of omeprazole, 750 mg of tetracycline, 400 mg of metronidazole and 300 mg of bismuth citrate) or symptom relief treatment with a single daily dose of omeprazole and bismuth citrate.
The authors then looked at the incidence of gastric cancer within the groups. Over 11.8 years of follow-up, 180,284 eligible participants were enrolled, and 1035 cases of gastric cancer were recorded. People who received anti-H. pylori therapy experienced a modest decrease in gastric cancer incidence, with a stronger reduction observed in those whose treatment successfully eradicated H. pylori compared with those whose treatment failed.
The researchers concluded that their results suggest mass screening and eradication of H. pylori could be an effective public health approach to prevent gastric cancer, which represents a new concept.
The second piece of research included on the page was a meta-analysis of randomised controlled trials and observational studies relating to H. pylori and gastric cancer. It found consistent evidence that H. pylori eradication therapy helps prevent gastric cancer. When all the data were combined, the meta-analysis suggested that those who received the eradication therapy for H. pylori experienced a 39% lower risk of developing gastric cancer compared wth those given a placebo or no therapy.
While decisions on population screening for H. pylori may not be something we consider too deeply in everyday general practice, this update provides a good reminder to consider the presence of H. pylori in people coming with symptoms of gastritis or peptic ulcer disease. It also prompted me to refresh my knowledge of these unusual bacteria, including the indications for testing for them, which include:
For more information on this, see this page.
This page brings together all of the different topics on H. pylori, including testing and treatment, although it is important to remember to follow our own local testing and treatment guidelines here in the Republic of Ireland.
If you have also been on a mission to reduce non-indicated PPI prescribing, you might find this page interesting too. It covers the complex relationship and mixed evidence about long-term use of PPIs and gastric cancer risk and is worth a read if you have the time or if you need to do some reading for your own CPD portfolio!