News release: National

May 27, 2003

For more information, call:
Laura H. Marshall
Kaiser Permanente
Phone: (510) 271-5826
E-mail: Laura.H.Marshall@kp.org

Kaiser Permanente Research: Many patients on acid-suppressing drugs for ulcer disease have neither ulcers nor H.pylori infection

Oakland, CA – In a study designed to evaluate the effectiveness of a “test and treat strategy” for Helicobacter pylori bacteria, Kaiser Permanente researchers found many patients diagnosed with peptic ulcer disease on the basis of their symptoms did not have ulcers documented by X-ray or endoscopy and less than 40% were infected with H.pylori.

Dr. James E. Allison is lead author on the study published in the May 27th issue of the Archives of Internal Medicine. He’s an adjunct investigator at Kaiser Permanente’s Division of Research in Oakland, California, and Clinical Professor of Medicine at the University of California, San Francisco.

“In community practices many patients are diagnosed with ulcers based on their symptoms,” says Dr. Allison. “These people are often prescribed acid suppression drugs with repeated refills. Rather than continue to refill their medication, their primary care physicians should check to see if peptic ulcer disease has ever been documented by X-ray or endoscopy.”

In Dr. Allison’s study, only 17% of the 650 patients in the study had X-ray or endoscopic proof of peptic ulcer disease (PUD). All 650 had been taking long-term (30% for at least one year and 28% for 6 or more years) acid suppression medications after being diagnosed with PUD by a physician. The study results suggest most of those patients actually had uninvestigated dyspepsia--upper abdominal pain or discomfort, a common problem in the U.S. and other Western countries.

“What this tells us is that automatic HP testing and treatment of patients with a diagnosis of undocumented PUD may not be an effective way to relieve their symptoms,” says Dr. Allison. “If a patient with ulcer-like abdominal pain receives acid-suppression therapy for a year and their symptoms aren’t relieved, it may be time for that patient to be tested for PUD with x-ray or endoscopy before proceeding with testing and treatment for HP.”

Kaiser Permanente is America’s leading integrated health care program. Founded in 1945, it is a not-for-profit, multi-specialty, group-practice prepayment program serving the health care needs of 8.4 million members in 9 states and the District of Columbia with headquarters in Oakland, Calif. Kaiser Permanente has research centers in 8 regions around the United States and publication of KP investigators’ work has appeared in the Journal of the American Medical Association, the New England Journal of Medicine, Pediatrics, the American Journal of Preventive Medicine, and other peer-reviewed medical journal.