I was interested to see the new PCSG guidelines on H. pylori (Guidelines in Practice, Jan/Feb 2000). It was good to get some clear guidance on managing non-ulcer dyspepsia. 1 am pleased that the concept of 'test and treat' has been put into perspective, if not actually laid to rest.

There are real problems in dealing with non-ulcer dyspepsia, such as how to manage patients who have tried either an H2 blocker or a PPI. I am still a bit worried that these guidelines, despite being authoritative and practical, will mask the inadequacies of ndoscopy provision nationally. I realise that part of our work as GPs is to protect our patients from excessive investigation, but I wonder if sometimes we camouflage under-provision.

Despite this, I was impressed by the guidelines and by Dr Mark Cottrill's excellent distillation of them. Many of the recommendations seemed very sensible, most notably if you don't want to treat H. pylori (in non-ulcer dyspepsia reflux), don't test!

After the plethora of regimens to treat H. pylori, it is good to see the simple one recommended. The discussion of antibiotic resistance is also useful – I will certainly be asking our laboratory about local resistance rates.

Dr Tim Harlow, GP, Devon

I could wax lyrical about Dr Nigel Watson's article on the audit of patients on lithium therapy in his practice (Guidelines in Practice, Aug/Sep 1999). I have already identified patients on lithium in my practice, and screened them as described in the article.

Dr David Archer, GP, Hertfordshire

Guidelines in Practice, March 2000, Volume 3
© 2000 MGP Ltd
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