Am Fam Physician. 2002 Oct 15;66(8):1402-1405.
to the editor: Thank you for the fine article by Drs. Meurer and Bower entitled,“Management of Helicobacter pylori Infection.”1 My only comment would regard the recommendation for family physicians to refer their patients “to a gastroenterologist for endoscopy.” Esophago-gastroduodenoscopy is a primary care procedure that is taught in many of our residency programs and at our own annual scientific assembly (along with colonoscopy).
With the prevalence of H. pylori infection demonstrated to be as high as 52 percent in the United States,2 it should be obvious that there are simply not enough gastroenterologists to see all of these patients (especially considering the primacy of screening colonoscopy over screening flexible sigmoidoscopy3). More family physicians need to step forward and accept the challenge of learning and providing these procedures for our patients.
1. Meurer LN, Bower DJ. Management of Helicobacter pylori infection. Am Fam Physician. 2002;65:1327–36.
2. Graham DY, Malaty HM, Evans DG, Evans DJ Jr, Klein PD, Adam E. Epidemiology of Helicobacter pylori in an asymptomatic population in the United States. Effect of age, race, and socioeconomic status. Gastroenterology. 1991;100:1495–501.
3. Lieberman DA, Weiss DG. One-time screening for colorectal cancer with combined fecal occult-blood testing and examination of the distal colon. N Engl J Med. 2001;345:555–60.
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