H pylori, child height and prostate cancer

Too busy to catch up on the latest research? Let Dr Louise Newson update you on recent journal papers.

Dyspepsia treatment - BMJ 2008; doi:10.1136/bmj.39479.640486
I find it difficult to know when to test for Helicobacter pylori in patients with dyspepsia. Is it best to treat their symptoms first and then test for H pylori if their symptoms are not controlled, or to test when they first present?

The study's results are reassuring. This randomised controlled trial of 699 patients with uninvestigated dyspepsia compared the strategy of 'test and treat' for H pylori infection against empirical acid suppression using a proton pump inhibitor.

Their results showed test-and-treat and acid suppression were equally cost-effective in the initial management of dyspepsia, meaning that empirical acid suppression is an appropriate initial strategy.

It should be noted that a reliable method for H pylori testing should be used, for example, urea breath test or stool antigen, because H pylori serology is too unreliable.

Communication improves beta-blocker compliance - Arch Intern Med 2008; 168: 477-83
Many patients stop taking their medication, including beta- blockers, as time passes following their MI.

Many methods have been tried in the past to improve compliance with medication for patients with chronic diseases.

This trial used a very simple intervention - writing letters to patients. Two letters were sent two months apart which detailed the importance of adherence to beta-blockers.

Results were impressive for such a simple and inexpensive intervention: for every 16 patients receiving the letters, one additional patient became adherent to beta-blockers.

Quality of life and prostate cancer treatment - N Engl J Med 2008; 358: 1,250-61
There are now many different treatment options available for patients with prostate cancer, each with different side-effects.

This prospective study measured outcomes reported by patients and also their spouses both before and after different treatments for prostate cancer - including radical prostatectomy, brachytherapy and external-beam radiotherapy.

Interestingly, adjuvant hormone therapy was associated with worse quality of life outcomes among these patients.

Patients in the brachytherapy group reported having long-lasting urinary irritation, bowel and sexual symptoms and transient problems with vitality or hormonal function.

Adverse effects of prostatectomy on sexual function were reduced by nerve-sparing procedures. Treatment-related symptoms were exacerbated by obesity, a large prostate size, a high PSA score, and older age.

It is important that patients and their spouses receive as much information as possible before embarking on treatment for their prostate cancer.

Child height screening programmes - Arch Dis Child 2008; 93: 278-84
Many children with a treatable cause of abnormal growth are still diagnosed at a late age, which can lead to a delay in treatment.

The role of height-screening programmes for primary-school aged children in identifying height-related disorders is currently unclear.

This systematic review of the effectiveness and economic modelling of height screening in primary-school aged children to identify height-related conditions was performed.

It found that height-screening programmes in primary-school aged children are likely to be cost-effective and give an additional yield of undiagnosed height-related conditions. They can lead to additional detection of other undiagnosed conditions for which short stature is a secondary presentation.

However, further research is needed to determine health utility gains and costs.

How intensive should cholesterol lowering be? - Heart 2008; 94: 434-9
I often feel that I am suboptimally treating patients with CHD with simvastatin (rather than atorvastatin) to lower their cholesterol but this is still the first-line drug of choice.

This article compounds my worries further. This was a secondary analysis of the Treating to New Targets study to investigate whether the benefits of intensive (atorvastatin 80mg) versus standard (atorvastatin 10mg) levels of lipid lowering are equally applicable to women and men with stable coronary heart disease.

The patients were followed up for nearly five years. The results showed that in both women and men, intensive treatment with atorvastatin 80mg significantly reduced the rate of major cardiovascular events compared with atorvastatin 10mg.

Perhaps we should be more aggressive with our cholesterol- lowering treatments.

Proactive patients and hypertension - Circulation 2008; 117: 1,361-8
We are all aware that patients' compliance to treatment improves when they are actively involved with their management decisions for those with chronic diseases.

This US study showed that control of hypertension can improve in diabetic patients when they shared the decision-making and proactively communicated with their doctors about any abnormal results of their BP self-monitoring.

An editorial accompanying the study suggests that other members of the healthcare team should ideally be trained to provide patients with more intensive disease education.

Dr Newson is a GP in the West Midlands and a member of our regular team of journal reviewers

The quick study

  • Acid suppression and 'test and treat' are equally cost-effective in the initial management of dyspepsia.
  • Post-MI patients' compliance with medication is improved by writing to them.
  • Prostate cancer treatments carry a range of side-effects, which should be discussed with the patient to help them decide what is best for them.
  • Height-screening in primary-school-aged children is likely to be cost-effective and give an additional yield of undiagnosed height-related conditions.
  • Cardiovascular events were significantly reduced in patients treated with atorvastatin 80mg.
  • Hypertension in patients with diabetes can be better controlled when patients and doctors share decision making.

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