Gastro-protective strategies in primary care in Italy: the "Gas.Pro." survey

Dig Liver Dis. 2010 May;42(5):359-64. doi: 10.1016/j.dld.2009.11.003. Epub 2009 Dec 11.


Introduction: Risk of gastrointestinal injury is relevant among users of anti-inflammatory or cardio-protective drugs. Adequate gastro-protection is warranted in high-risk patients.

Aim: To assess the perceptions and practices of Italian primary care physicians regarding gastro-protective strategies.

Methods: Nationwide cross-sectional observational study. A 14-question survey questionnaire was administered to 112 primary care physicians throughout Italy. Data collection covered consecutive outpatient candidates for the prescription of a potentially GI harmful medication, observed in the physicians' office over a 3-week period.

Results: Cohort included 3943 cases (2489 naïve and 1463 chronic NSAID/ASA users). Mean age and prevalence of cardiovascular comorbidity were significantly higher in the latter subgroup. Non-selective NSAIDs and low-dose aspirin were the most commonly prescribed drugs. Combined NSAIDS/ASA plus steroids/anticoagulant/antiplatelets were recorded in 161 cases. Helicobacter pylori status was known in only 38% of naïve and 33.2% of chronic users, being negative in 85.3% and 89.5%, respectively. When positive, H. pylori was eradicated by almost all physicians (97.9%), but in case of unknown H. pylori status, the presence of infection was investigated in only 8.6% and 14.9% of patients in the two subgroups. Gastro-protection was endorsed in 80.7% of patients, mostly PPIs (91%). In patients aged over 70, pantoprazole and lansoprazole were the preferred gastro-protective agents.

Conclusions: There is a significant over-use of gastro-protection in the primary care setting in Italy and the role H. pylori is largely overlooked. Educational efforts should be directed to a more targeted gastro-protection only for at-risk patients as well as improved adherence to recommendations for testing and treating H. pylori infection.

MeSH terms

  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Cross-Sectional Studies
  • Female
  • Gastrointestinal Hemorrhage / chemically induced
  • Gastrointestinal Hemorrhage / microbiology
  • Gastrointestinal Hemorrhage / prevention & control*
  • Helicobacter Infections / complications
  • Helicobacter Infections / diagnosis*
  • Helicobacter pylori / isolation & purification
  • Humans
  • Italy
  • Male
  • Middle Aged
  • Physicians, Family
  • Practice Patterns, Physicians'*
  • Proton Pump Inhibitors / therapeutic use*


  • Anti-Inflammatory Agents, Non-Steroidal
  • Proton Pump Inhibitors