Knowledge Regarding H.Pylori Management Among Hospital Doctors in Benghazi, Libya

Abdelhakim M. Elbarsha; Salah Eldin A. Amer; Rabha A. M. El Sahly

المؤلفون

Abdelhakim M. Elbarsha Assistant Professor, Department of Medicine, Faculty of Medicine, University of Benghazi, Benghazi, Libya
Salah Eldin A. Amer Lecturer, Department of Medicine, Faculty of Medicine, University of Benghazi, Benghazi, Libya
Rabha A. M. El Sahly Assistant Professor, Department of Medicine, Faculty of Medicine, University of Benghazi, Benghazi, Libya

الكلمات المفتاحية:

H.Pylori، Helicobacter Pylori، Peptic ulcer، MALT lymphoma، Dyspepsia

الملخص

Helicobacter pylori (H. pylori) affects almost half of the world population. The infection is more prevalent in developing countries (up to 90%) especially in societies with lower socioeconomic status. Doctors' knowledge about management of H.Pylori infection is a subject of continuous evaluation, given the worldwide high prevalence, and variations in diagnostic methods and treatment regimens. This is cross-sectional observational, questionnaire-based study that explored the knowledge background about managing H.Pylori infection among trainee doctors in Benghazi hospitals, where 150 doctors were asked to fill in the questionnaire. Hundred and eleven responded (74.0%). The most frequent symptoms thought by the participants to be caused by H.Pylori infection were epigastric pain (77.5%) and heartburn (62.2%). Forty-nine participants (out of 108 (45.3%)) preferred prescribing eradication for all patients with confirmed infection. Thirty-six (out of 94) (38.3%) participants preferred the antibiotic combination of amoxycillin and clarithromycin. The most preferred test for confirmation of H.Pylori eradication was fecal antigen test (82 out of 111(73.9%)). There is a clear knowledge gap among hospital doctors working in secondary care hospitals in Benghazi, regarding the symptomatology, and management of H.Pylori infection. Our findings are comparable to many similar observations worldwide.

المراجع

Suerbaum S, Michetti P. Helicobacter pylori Infection. N Engl J Med. 2002 Oct 10;347(15):1175–86.

Bardhan PK. Epidemiological features of Helicobacter pylori infection in developing countries. Clin Infect Dis Off Publ Infect Dis Soc Am. 1997 Nov;25(5):973–8.

Boltin D, Kimchi N, Dickman R, Gingold-Belfer R, Niv Y, Birkenfeld S. Attitudes and practice related to Helicobacter pylori infection among primary care doctors. Eur J Gastroenterol Hepatol. 2016 Sep;28(9):1035–40.

Niv Y, Birkenfield S. Gastroesophageal reflux disease: a need for guidelines for the primary care doctor. Isr Med Assoc J IMAJ. 2002 Sep;4(9):684–6.

Na’amnih W, Katz R, Goren S, Ben-Tov A, Ziv-Baran T, Chodick G, et al. Correlates of gastroenterology health-services utilization among patients with gastroesophageal reflux disease: a large database analysis. Isr J Health Policy Res. 2019 Dec;8(1):66.

Ishaq S, Nunn L. Helicobacter pylori and gastric cancer: a state of the art review. Gastroenterol Hepatol Bed Bench. 2015;8(Suppl 1):S6–14.

Cassel CK, Guest JA. Choosing wisely: helping doctors and patients make smart decisions about their care. JAMA. 2012 May 2;307(17):1801–2.

Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol. 2017 Feb;112(2):212–39.

Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol. 2022 Jan;117(1):27–56.

Katelaris, Peter, et al. "Helicobacter pylori world gastroenterology organization global guideline." Journal of clinical gastroenterology 57.2 (2023): 111-126.

National Institute for Health and Care Excellence: Guidelines. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management [Internet]. London: National Institute for Health and Care Excellence (NICE); 2019 [cited 2022 Nov 25]. (National Institute for Health and Care Excellence: Guidelines). Available from: http://www.ncbi.nlm.nih.gov/books/NBK552570/

Malfertheiner P, Megraud F, O’Morain CA, Atherton J, Axon ATR, Bazzoli F, et al. Management of Helicobacter pylori infection—the Maastricht IV/ Florence Consensus Report. Gut. 2012 May;61(5):646–64.

Wu Y, Su T, Zhou X, Lu N, Li Z, Du Y. Awareness and attitudes regarding Helicobacter pylori infection in Chinese doctors and public population: A national cross-sectional survey. Helicobacter. 2020 Aug;25(4):e12705.

Canbaz S, Sunter AT, Peksen Y, Leblebicioglu H. Survey of general practitioners’ knowledge about Helicobacter pylori infection. BMC Gastroenterol. 2005 Jan 26;5:4.

Sharma VK, Howden CW. A national survey of primary care doctors’ perceptions and practices related to Helicobacter pylori infection. J Clin Gastroenterol. 2004 Apr;38(4):326–31.

Ahmed S, Salih M, Jafri W, Ali Shah H, Hamid S. Helicobacter pylori infection: approach of primary care doctors in a developing country. BMC Gastroenterol. 2009 Dec;9(1):23.

Cano-Contreras AD, Rascón O, Amieva-Balmori M, Ríos-Gálvez S, Maza YJ, Meixueiro-Daza A, et al. Approach, attitudes, and knowledge of general practitioners in relation to Helicobacter pylori is inadequate. There is much room for improvement! Rev Gastroenterol Mex Engl. 2018 Mar;83(1):16–24.

1Fischbach W, Zerl A, Klassert C. [How do primary care doctors manage their patients with Helicobacter pylori infection? Results of a survey and their implementation into the German S2k guideline 2016]. Z Gastroenterol. 2017 Feb;55(2):136–9.

Moayyedi P, Forman D, Braunholtz D, Feltbower R, Crocombe W, Liptrott M, et al. The proportion of upper gastrointestinal symptoms in the community associated with Helicobacter pylori, lifestyle factors, and nonsteroidal anti-inflammatory drugs. Leeds HELP Study Group. Am J Gastroenterol. 2000 Jun;95(6):1448–55.

Sugano K. Screening of gastric cancer in Asia. Best Pract Res Clin Gastroenterol. 2015 Dec;29(6):895–905.

Ferwana M, Abdulmajeed I, Alhajiahmed A, Madani W, Firwana B, Hasan R, et al. Accuracy of urea breath test in Helicobacter pylori infection: meta-analysis. World J Gastroenterol. 2015 Jan 28;21(4):1305–14.

McNicholl AG, Amador J, Ricote M, Cañones-Garzón PJ, Gene E, Calvet X, et al. Spanish primary care survey on the management of Helicobacter pylori infection and dyspepsia: Information, attitudes, and decisions. Helicobacter. 2019 Aug;24(4):e12593.

Huang J, Lam SK, Malfertheiner P, Hunt RH. Has education about Helicobacter pylori infection been effective? Worldwide survey of primary care doctors. J Gastroenterol Hepatol. 2003 May;18(5):512–20.

NIH Consensus Conference. Helicobacter pylori in peptic ulcer disease. NIH Consensus Development Panel on Helicobacter pylori in Peptic Ulcer Disease. JAMA. 1994 Jul 6;272(1):65–9.

Weijnen CF, Numans ME, de Wit NJ, Smout AJ, Moons KG, Verheij TJ, et al. Testing for Helicobacter pylori in dyspeptic patients suspected of peptic ulcer disease in primary care: cross sectional study. BMJ. 2001 Jul 14;323(7304):71–5.

Mansour Ghanaei1 F, Joukar F, Soati F, Gharib S. Knowledge and Practice of General Practitioners and Internists about Helicobacter pylori infection in Guilan, Iran. Middle East J Dig Dis. 2011 Sep;3(2):119–25.

Montes Teves PA, Soria Medina JI, Gamarra Espinoza ZI, Monge Salgado E. [The doctor’s attitude towards infection by Helicobacter pylori in clinical practice]. Rev Gastroenterol Peru Organo Of Soc Gastroenterol Peru. 2002 Sep;22(3):221–7.

Boltin D, Dotan I, Birkenfeld S. Improvement in the implementation of Helicobacter pylori management guidelines among primary care doctors following a targeted educational intervention. Ann Gastroenterol. 2019 Feb;32(1):52–9.

Siddique O, Ovalle A, Siddique AS, Moss SF. Helicobacter pylori Infection: An Update for the Internist in the Age of Increasing Global Antibiotic Resistance. Am J Med. 2018 May;131(5):473–9.

Song C, Xie C, Zhu Y, Liu W, Zhang G, He S, et al. Management of Helicobacter pylori infection by clinicians: A nationwide survey in a developing country. Helicobacter. 2019 Dec;24(6):e12656.

González-Huezo MS, Rojas-Sánchez A, Rosales-Solís AA, Miranda-Cordero RM, Hinojosa-Ruiz A, Mejía-García E, et al. [Helicobacter pylori eradication frequency with the conventional triple therapy in adult patients at the Centro Médico Issemym]. Rev Gastroenterol Mex. 2012 Sep;77(3):114–8.

Escala Perez-Reyes AY, Jiménez Carranza AE, Bussalleu Rivera A. [How do gastroenterologists in Peru deal with Helicobacter pylori infection? Study based on a survey conducted in 2014]. Rev Gastroenterol Peru Organo Of Soc Gastroenterol Peru. 2015 Dec;35(4):295–305.

Boehnke KF, Valdivieso M, Bussalleu A, Sexton R, Thompson KC, Osorio S, et al. Antibiotic resistance among Helicobacter pylori clinical isolates in Lima, Peru. Infect Drug Resist. 2017;10:85–90.