The British journal of general practice : the journal of the Royal College of General Practitioners
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It is known that at least 90% of duodenal ulcers are caused by infection with the bacterium Helicobacter pylori. Eradicating this organism usually results in complete resolution of the disease. Testing for H pylori was introduced relatively recently, and thus, many patients known to have uncomplicated peptic ulcer disease who continue to need long-term treatment with ulcer-healing drugs have never been tested for the infection or offered eradication therapy. In modern computerized practices, this subgroup of patients can readily be identified by reference to morbidity and repeat prescribing data. Eradication of H pylori infection in this group of patients has great potential benefit for the individuals concerned as well as cost-saving benefit for the National Health Service. ⋯ Testing for and eradication of H pylori is worthwhile in general practice in those patients with previous proven duodenal ulceration who need long-term ulcer-healing medication. The high rate of eradication of H pylori achieved with the regimen used in this study compares very favourably with that of other treatment regimens. However, in patients with duodenal ulcers there may be coexisting pathology, and H pylori eradication does not necessarily result in complete disappearance of dyspeptic symptoms. Thus, when monitoring the outcome of treatment it is important to assess improvement of symptoms as well as objective evidence of eradication.
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Low back pain is a common and persistent problem. Research studies seeking to improve the quality of management of this condition have tended to ignore the opinions of patients. There is a growing acceptance of the importance of taking patients' views into account in developing management and educational programmes for a variety of conditions. ⋯ Patients' views on low back pain are heterogeneous. The dissatisfaction expressed with medical explanations for the pain may be related to superficial clinical management and the constraints of general practice. Good management of low back pain needs to take patients' complex views of the condition into account.