Portal de Periódicos da CAPES

The melanoma epidemic

1996; BMJ; Volume: 312; Issue: 7042 Linguagem: Inglês

10.1136/bmj.312.7042.1362b

0959-8138

R.M. MacKie, Robin Marks, Adèle C. Green,

Cutaneous Melanoma Detection and Management

negative for H pylori admitted to flare ups of pain.2The fact that such symptoms probably resulted from coexistent reflux or functional bowel disease rather than recurrence of ulcer is not important in this context.Deferring retesting of patients' H pylori status until symptomatic relapse has a superficial economic appeal, as the urea breath test is relatively expensive.The savings made through not retesting patients who remain asymptomatic will, however, be partly offset by the extra costs of treating patients who suffer a relapse.Even simple relapse will incur added costs (drugs, consultations, loss of work) before repeat testing is arranged, and the costs of just one complication would finance many breath tests.In a 12 month follow up study, among 66 patients with ulcer who remained positive for H pylori after eradication treatment two bled from an ulcer and two were admitted to hospital with abdominal pain.3Excluding patients with a history of complicated ulcer and advising patients to reconsult if symptoms recur will not remove the possibility of patients presenting with severe symptoms or complications.Sonnenberg and Townsend esti- mated the costs of treating duodenal ulcer with alternative management strategies, including treatment to eradicate H pylori both with and without subsequent testing for H pylori.4 When use of a post-treatment test costing up to $400 was assumed, routine verification of eradication seemed less expensive than awaiting symptomatic recurrence and resulted in patients spend- ing less time with active ulceration.Evidence is accumulating to support a change from Schwartz's dictum of "no acid, no ulcer" to "no Hpylori, no ulcer."But what about "no pain, no H pylori"? We urge caution in the implemen- tation of a symptom based assessment of Hpylori status after treatment, doubting both its reliabil- ity and its cost effectiveness.It seems harsh to require some patients to suffer a recurrence of symptoms before establishing whether the treat- ment has been effective.The wider provision of H pylori testing services should be a priority; patients' wellbeing should not be risked for mar- ginal cost savings.