Gastro-protective strategies in primary care in Italy: The “Gas.Pro.” survey

Abstract Introduction Risk of gastrointestinal injury is relevant among users of anti-inflammatory or cardio-protective drugs. Adequate gastro-protection is warranted in high-risk patients. Aim To assess the perceptions and practices of Italian primary care physicians regarding gastro-protective str...

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Bibliographic Details
Published in:Digestive and liver disease 2010-05, Vol.42 (5), p.359-364
Main Authors: Bianco, Maria A, Rotondano, Gianluca, Buri, Luigi, Tessari, Francesco, Cipolletta, Livio
Format: Article
Language:English
Subjects:
Aged
Anti-Inflammatory Agents, Non-Steroidal - adverse effects
Cross-Sectional Studies
Drug-related GI injury
Female
Gastro-protection
Gastroenterology and Hepatology
Gastrointestinal Hemorrhage - chemically induced
Gastrointestinal Hemorrhage - microbiology
Gastrointestinal Hemorrhage - prevention & control
Helicobacter Infections - complications
Helicobacter Infections - diagnosis
Helicobacter pylori - isolation & purification
Humans
Italy
Male
Middle Aged
Physicians, Family
Practice Patterns, Physicians
Preventive strategies
Primary care
Proton Pump Inhibitors - therapeutic use
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Summary:Abstract Introduction Risk of gastrointestinal injury is relevant among users of anti-inflammatory or cardio-protective drugs. Adequate gastro-protection is warranted in high-risk patients. Aim To assess the perceptions and practices of Italian primary care physicians regarding gastro-protective strategies. Methods Nationwide cross-sectional observational study. A 14-question survey questionnaire was administered to 112 primary care physicians throughout Italy. Data collection covered consecutive outpatient candidates for the prescription of a potentially GI harmful medication, observed in the physicians’ office over a 3-week period. Results Cohort included 3943 cases (2489 naïve and 1463 chronic NSAID/ASA users). Mean age and prevalence of cardiovascular comorbidity were significantly higher in the latter subgroup. Non-selective NSAIDs and low-dose aspirin were the most commonly prescribed drugs. Combined NSAIDS/ASA plus steroids/anticoagulant/antiplatelets were recorded in 161 cases. Helicobacter pylori status was known in only 38% of naïve and 33.2% of chronic users, being negative in 85.3% and 89.5%, respectively. When positive, H. pylori was eradicated by almost all physicians (97.9%), but in case of unknown H. pylori status, the presence of infection was investigated in only 8.6% and 14.9% of patients in the two subgroups. Gastro-protection was endorsed in 80.7% of patients, mostly PPIs (91%). In patients aged over 70, pantoprazole and lansoprazole were the preferred gastro-protective agents. Conclusions There is a significant over-use of gastro-protection in the primary care setting in Italy and the role H. pylori is largely overlooked. Educational efforts should be directed to a more targeted gastro-protection only for at-risk patients as well as improved adherence to recommendations for testing and treating H. pylori infection.
ISSN:1590-8658
1878-3562
DOI:10.1016/j.dld.2009.11.003