Do We Eradicate<i>Helicobacter pylori</i>in Hospitalized Patients with Peptic Ulcer Disease?

BACKGROUND & AIMS:Expert consensus mandates retesting for eradication of Helicobacter pylori infection after treatment, but it is not clear how many patients are actually retested. We evaluated factors associated with retesting for H pylori in a large, nationwide cohort. METHODS:We performed a retrospective cohort study of patients with H pylori infection (detected by urea breath test, stool antigen, or pathology) who were prescribed an eradication regimen from January 1, 1994 through December 31, 2018 within the Veterans Health Administration (VHA). We collected data on demographic features, smoking history, socioeconomic status, facility poverty level and academic status, and provider specialties and professions. The primary outcome was retesting for eradication. Statistical analyses included mixed-effects logistic regression. RESULTS:Of 27,185 patients prescribed an H pylori eradication regimen, 6486 patients (23.9%) were retested. Among 7623 patients for whom we could identify the provider who ordered the test, 2663 patients (34.9%) received the order from a gastroenterological provider. Female sex (odds ratio, 1.22; 95% CI, 1.08-1.38; P [ .002) and history of smoking (odds ratio, 1.24; 95% CI, 1.15-1.33; P < .001) were patient factors associated with retesting. There was an interaction between method of initial diagnosis of H pylori infection and provider who ordered the initial test (P < .001). There was significant variation in rates of retesting among VHA facilities (P < .001). CONCLUSIONS:In an analysis of data from a VHA cohort of patients with H pylori infection, we found low rates of retesting after eradication treatment. There is significant variation in rates of retesting among VHA facilities. H pylori testing is ordered by nongastroenterology specialists two-thirds of the time. Confirming eradication of H pylori is mandatory and widespread quality assurance protocols are needed.

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Low Rates of Retesting for Eradication of Helicobacter pylori Infection After Treatment in the Veterans Health Administration

Kumar

Metz

Kaplan

et al. 2021

Clinical Gastroenterology and Hepatology

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Helicobacter pylori‐associated peptic ulcer disease: A retrospective analysis of post‐treatment testing practices

Feder

Posner

et al. 2018

Helicobacter

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Background & Aims Guidelines recommend that patients with Helicobacter pylori (H. pylori)‐associated peptic ulcer disease (PUD) receive H. pylori eradication therapy followed by post‐treatment testing to prove eradication; however, post‐treatment testing rates are suboptimal and barriers to testing are poorly understood. Our aim was to identify factors that predicted receipt of post‐treatment testing. Methods We performed a retrospective cohort study of 152 patients with H. pylori‐associated PUD diagnosed between 2007 and 2015 at a large tertiary medical center in the United States, who received standard eradication therapy and ambulatory follow‐up within one year. The primary outcome of interest was receipt of post‐treatment testing. Logistic regression models compared post‐treatment testing rates in those diagnosed while outpatient vs inpatient, patients with vs without repeat endoscopy, and patients with vs without gastroenterology (GI) clinic follow‐up. Propensity scores controlled for age, sex, race, ulcer location, and symptom persistence. Results Among 152 patients, 67 (44%) patients received post‐treatment testing. There were significant differences in post‐treatment testing rates in those diagnosed as outpatients vs inpatients (57% vs 33%; OR 3.87, P = 0.001) and in patients with vs without GI follow‐up (62% vs 11%; OR 9.85, P < 0.0001). Conclusions The rate of testing for eradication after treatment in patients with H. pylori‐ associated PUD was low. However, this was significantly improved in patients who have GI follow‐up and whose diagnosis was made in the outpatient setting. Our study demonstrates a clear opportunity for quality improvement initiatives.

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Do We EradicateHelicobacter pyloriin Hospitalized Patients with Peptic Ulcer Disease?

Abstract: There was substantial discrepancy between the number of diagnosed H pylori infections and the rate of treatment as well as confirmation of eradication. Numerous approaches could be taken to improve treatment and eradication confirmation.

Cited by 2 publications

References 20 publications

Low Rates of Retesting for Eradication of Helicobacter pylori Infection After Treatment in the Veterans Health Administration

Low Rates of Retesting for Eradication of Helicobacter pylori Infection After Treatment in the Veterans Health Administration

Helicobacter pylori‐associated peptic ulcer disease: A retrospective analysis of post‐treatment testing practices

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