Empire implements AGA, ACG guidelines for evaluation and management of dyspepsia and PUD

Empire BlueCross BlueShield today announced an initiative to inform and educate physicians and consumers about important findings from the American Gastroenterological Association (AGA) and the American College of Gastroenterology (ACG) related to a little known but common infection that is a precursor to serious stomach ailments.

An estimated 30 to 40 percent of the United States population is infected with Helicobacter pylori (H. pylori), a causative agent linked to the development of adverse health conditions such as peptic ulcer disease (PUD), gastric malignancy and dyspeptic symptoms. Guidelines from the AGA and the ACG recommend an approach to H. pylori that includes testing, treating, and retesting and confirming eradication. Moreover, the guidelines promote awareness of inappropriate serology use and the long-held practice of using empirical proton-pump inhibitor (PPI) therapy as a first line of treatment. 

Empire BlueCross BlueShield is implementing the guidelines set forth by the AGA and ACG for the evaluation and management of dyspepsia and PUD, as they promote improved effectiveness in patient care and quality for those who suffer from H. pylori infection.  

"We are very pleased to offer Empire BlueCross BlueShield members access to this important, quality information that can help them improve their health," said Michael Jaeger, M.D., a medical director with Empire's parent company, and project leader for the H. pylori initiative. "Prior to the guidelines, many patients who have dyspepsia without reflux symptoms were not being tested for H. pylori. Instead they were given a PPI, which masks patients' symptoms. Patients may feel better, but they are not being appropriately tested and treated, and, as a result, the H. pylori is not eradicated," he said.

The AGA and ACG guidelines indicate that long-term use of a PPI is not beneficial for patients with H. pylori, yet all too often, a PPI is utilized and patients stay on it for years. In addition, the guidelines recommend that patients under age 55, with no known major health issues, can be tested in a primary care setting with a non-invasive active infection test, such as the stool antigen test, HpSA®, developed by Meridian Bioscience, Inc.

"This is really great for improved clinical utility, quality of care, lower co-pays and less anxiety for our members to receive this care. The new guidelines will improve treatment protocols and, subsequently, help improve the overall health of many Americans," Jaeger noted.

Empire's awareness campaign about the AGA and ACG guidelines is intended to have a positive impact on informing and educating physicians and consumers about the importance of active infection testing for H. pylori, such as with the HpSA test.

The new recommendations emphasize the need to discontinue serology testing and to test, treat and retest symptomatic patients as well as confirm eradication utilizing active H. pylori infection testing. In addition, the guidelines call for testing for active infection prior to having a PPI prescribed for many patients. 

"Rapid diagnostics, such as our HpSA test, detects active H. pylori infection," said Jack Kraeutler, chief executive officer of Meridian Bioscience. "These rapid tests provide their greatest utility when used by physicians to help make good treatment decisions. Improving patient well-being and clinical efficiencies, while reducing health care costs is our key goal and we are delighted to be a part of this important effort."

According to the guidelines it is important to test for active H. pylori infection because studies indicate that about 50 percent of patients with a positive H. pylori serology do not have active infection.

Serologic use is no longer recommended because it has poor predictive value and leads to unnecessary antibiotic use and increased antibiotic resistance; it does not test for active infection, and has an increased incidence of side effects of treatment; and it does not confirm eradication and leads to increased patient anxiety over implications of a positive test.

"Our mission is to improve the health of our members and our communities," said Scott Breidbart, M.D., chief medical officer for Empire. "By reinforcing the important guidelines set forth by the AGA and ACG, we will help promote best practices for those who may need to be treated for the bacteria. And by recommending use of recommended testing and protocol for H. pylori, we will correctly identify people who have the disease. This, in turn, will help reduce avoidable adverse health conditions and the problems caused when accepted guidelines are not followed."


Empire BlueCross BlueShield


The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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