MANAGEMENT OF GASTROINTESTINAL DISEASES IN PRIMARY CARE: A SURVEY IN NINE COUNTRIES OF CENTRAL AND EASTERN EUROPE

B. Seifert (1), M. Palka (2), N. Kral (1), A. Windak (2), G. Rubin (3)

1. Charles University, Dpt.of General Practice, Prague, Czech Republic,
2. University of Krakow, Dpt. of Family Medicine, Poland,
3. Durham University School of Medicine and Health, Wolfson Research Institute, Stockton on Tees, UK

INTRODUCTION: A survey of the management of GI disorders in primary care has shown wide variations in practice both between and within European countries. This reflects different health care systems and differing levels of knowledge and awareness. Little is known about the situation in the Central and Eastern Europe (CEE)

AIMS & METHODS: Using a previously validated self-completion questionnaire we undertook a postal survey of randomly selected general practitioners (GPs) from 9 CEE countries. (Bulgaria, Czech Rep., Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia and Slovenia). The questionnaire was translated to all languages.

RESULTS: We received 859 responses (response rate 39%, range 28-42%). 572 (66.6%) of respondents were female; the mean age of all respondents was 49.4 years with a mean of 18.7 years practice experience. An open access to upper endoscopy resp. colonoscopy reported 65-95% GPs, less in Poland (28%, resp. 26%), Lithuania (55%, resp. 26%) and Bulgaria. 38% of respondents had access to UBT testing for H pylori infection; 23% had access to stool antigen tests. For a range of common GI problems (GERD, dyspepsia, IBS and colorectal cancer) over 80% of respondents usually or always used guidelines. A step down approach to GERD management is used by 57.7% of respondents, while a therapeutic trial with PPI is used by 63%. For uninvestigated dyspepsia under 45 a wide range of management approaches are employed, though empirical treatment with a PPI is the most common. H pylori eradication is not used or not available for 22.5% of respondents. For younger patients with rectal bleeding and no alarm symptoms, 40% of respondents would usually or always request a colonoscopy. Double contrast barium enema was commonly utilised in Latvia, Lithuania and Bulgaria. For colorectal cancer screening, almost all respondents from the Czech Republic, Slovakia and Slovenia perform FOBT, while respondents from other countries referred patients to specialists.

CONCLUSION: Variations in availability of tests for H pylori, access to upper and lower GI endoscopy and approach to colorectal cancer screening were found. The differencies in the management of GI disorders in CEE countries are less than expected and comparable to those found in a previous survey of northern and Mediterrean Europe. These findings may reflect the uptake of national and international guidelines in CEE countries.