Establishing a Consensus Algorithm for H. Pylori Screening, Diagnosis, Initial Management, and Referral Protocols for Primary Care Physicians.

Abstract

Background: Helicobacter pylori (H. pylori) infection is a significant public health concern, contributing to various gastrointestinal disorders, including peptic ulcers and gastric cancer. The infection is highly prevalent in Africa, but still diagnostic and treatment challenges persist in primary care settings. Effective treatment regimens are therefore crucial for eradicating this infection and preventing complications.  This study aimed to develop a consensus-based algorithm for H. pylori management optimized for Primary care settings utilizing data from primary care physicians, patient screening, and treatments.

Methodology: A cross-sectional study was conducted among forty-four primary care physicians involved in diagnosing and treating H. pylori infection. They were provided with a data Collection Form (DCF) and an H. pylori rapid antibody test kit. All the questionnaire responses and the result of rapid antibody test were recorded and analyzed. A panel of experts involving senior family medicine doctors, and a gastroenterologist via a modified Delphi process of discussions on the DCF responses, and test results from the 44 physicians arrived at a consensus-based treatment algorithm developed to guide clinical decision-making for H. pylori management.

Results: This study comprised 245 patients with a female preponderance and mean age of 35.0±11.5 years. The most common symptoms from the DCF were epigastric pain, nausea/vomiting and bloating in 74.5%, 52.7% and 35% respectively while the mean duration of symptoms was 3weeks. Constipation and irritability were the least common symptoms with heartburn reported less frequently in the H. Pylori positive cases. 79.9% of the 245 patients were H. Pylori treatment naïve with a higher likelihood (57.1%) of having a positive antibody test. It was recommended that both treatment experienced and naïve patients with epigastric or abdominal pain, nausea vomiting and/or bloating with symptom duration > 2weeks be tested and eradicated while those with alarm symptoms be referred to the specialist.

Conclusion: The proposed algorithm provides a comprehensive guide for Physicians at the primary and secondary care level in selecting the most effective treatment regimen for H. pylori infection. H. Pylori antibody testing is a primary screening tool for patients with persistent symptoms or those lasting greater than 2weeks and where positive confirmatory test is recommended.