Continuation of proton pump inhibitors from hospital to community.

OBJECTIVES: To evaluate the appropriateness of initiation of proton pump inhibitor (PPI) treatment in hospital, the quality of discharge information, and any association with continued treatment in the community. METHOD: Survey of all inpatients newly initiated on a PPI in June-August 2003. Assessment of appropriateness of therapy and completeness of discharge information; assessment of continuation of PPI therapy in the community after 6 months. RESULTS: Thirty-five of 58 patients (60%) were considered appropriately commenced on PPI treatment. Less than 25% of patients discharged on a PPI had discharge information recommending duration of treatment or review. In the "appropriate" group 30 patients (86%) were discharged on omeprazole, and 13/21 (62%) evaluable patients remained on this at 6 months. In the "inappropriate" group 15 (65%) were discharged on omeprazole, and 10/14 (71%) evaluable patients remained on this at 6 months. Older patients remained on omeprazole for a longer duration but appropriateness of commencement did not influence the duration of treatment. Dose titration was attempted for 10 (29%) patients including three from the "inappropriate" group. CONCLUSION: Care should be taken to commence PPIs only when clinically indicated. Discharge information to GPs, especially recommendations for duration of treatment and/or dose titration, requires improvement.

Antibiotic resistance in Helicobacter pylori: is it a problem in New Zealand?

AIMS: Infection with Helicobacter pylori requires antibiotic treatment when associated with upper gastrointestinal symptoms. Antibiotic susceptibility tests on this pathogen are rarely carried out and there is little information available on the incidence of antibiotic resistant strains in New Zealand. The aim of this study was to assess the susceptibility of H. pylori (cultured from gastric biopsies in Dunedin) to antibiotics that are commonly used in treatment. METHODS: Over a 13-month period, gastric biopsies were obtained from selected patients undergoing endoscopy at Dunedin Public Hospital because of upper gastrointestinal symptoms. Biopsies were cultured for H. pylori and examined histologically. Fifty isolates from 50 patients with histological findings compatible with H. pylori infection were tested for sensitivity to metronidazole, clarithromycin, amoxycillin, and tetracycline using the epsilometer (E-) test. RESULTS: Metronidazole resistance was detected in 10 (20%) isolates. These isolates were highly resistant to metronidazole and were not inhibited by 250 mg/L. Resistance to clarithromycin, amoxycillin, and doxycycline was not detected. CONCLUSIONS: Clinicians should be aware that resistance to metronidazole appears to be common in H. pylori in New Zealand and that treatment regimens including this antibiotic may be less effective as a result. Although clarithromycin resistance was not detected, it is becoming increasingly problematical overseas and has been recorded in Auckland.

Prevalence and correlates of irritable bowel symptoms in a New Zealand birth cohort.

AIM: To determine the prevalence and correlates of bowel symptoms and the irritable bowel syndrome (IBS) in a birth cohort of young New Zealanders. METHODS: Participants in the Dunedin Multidisciplinary Health and Development Study at age 26 completed a validated Bowel Disease Questionnaire expressing their experience of clearly defined symptoms over the previous 12 months. RESULTS: 980 participants (499 male, 481 female, comprising 96% of the birth cohort) completed the questionnaire. Sixty four per cent had at least one of the measured symptoms; abdominal pain was reported in 46.5%, chronic constipation in 9.1%, and chronic diarrhoea in 17.1%. A diagnosis of IBS could be made by using two or more of Manning's diagnostic criteria in 18.8%, three or more criteria in 10.3%, and more than three in 3.3%. Symptoms were more than twice as frequent and severe in females than males. CONCLUSIONS: Bowel-related abdominal symptoms, including those required for a diagnosis of IBS, are very common in 26-year-old New Zealanders; the prevalence of these symptoms is very similar to that recorded previously in Europe and the USA.