How Well Is Heliobacter pylori Treated?

Yogeswaran, Kumaresan; Chen, Grant; Cohen, Lawrence E.; Cooper, Mary Anne; Yong, Elaine; Hsieh, Eugene; Rowsell, Corwyn; Saibil, Fred; Tinmouth, Jill

doi:10.14309/00000434-200809001-00964

Cited by 6 publications

(10 citation statements)

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“…This finding of outpatients receiving superior care relative to inpatients is consistent with a prior Canadian study, which demonstrated higher H. pylori treatment rates in outpatients compared to inpatients . Most similar to the present analysis, a small single‐center Canadian study by Yogeswaran et al reported that inpatient status was a significant barrier to receiving post‐treatment testing; however, this was only based on a 22‐person cohort. The Yogeswaran study also had a nonsignificant trend toward GI follow‐up as a positive predictor of receiving post‐treatment testing.…”

Section: Discussionsupporting

confidence: 91%

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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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Section: Discussionsupporting

confidence: 91%

“…Prior studies have demonstrated eradication therapy rates ranging from 50% to 90% and post‐treatment testing rates of approximately 30%‐40% . While explanations for suboptimal rates of eradication therapy have been reported, the reasons for low rates of post‐treatment testing are not well described …”

Section: Background and Aimsmentioning

confidence: 99%

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

Feder

Posner

et al. 2018

Helicobacter

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“…Limitations of the present study were confined to the experiences of a single centre; however, similar findings of low treatment rates and confirmation testing were also reported in other studies (14)(15)(16).…”

Section: Discussionsupporting

confidence: 60%

“…A recent study performed in Toronto (Ontario) (14) examined the rates of treatment for both outpatients and inpatients undergoing EGD for various indications. The investigators found that 90% of all patients were treated appropriately; however, subgroup analysis revealed that inpatients were significantly less likely to receive appropriate therapy (71%).…”

Section: Discussionmentioning

confidence: 99%

Do We EradicateHelicobacter pyloriin Hospitalized Patients with Peptic Ulcer Disease?

Wong

Svarta

et al. 2013

Canadian Journal of Gastroenterology

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“…Regardless of the type of therapy used, study from Canada showed widespread failure to comply with test and treat in up to 10% of cases and a failure to confirm eradication in 32% [6]. This illustrates that efficacious first-line therapy will always depend on adherence to guidelines by physicians and compliance with therapy by patients.…”

Section: Triple Therapymentioning

confidence: 76%

Treatment of Helicobacter pylori infection 2012

et al. 2012

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Helicobacter pylori resistance rates to antibiotics vary in different countries and even in different regions of the same country. Choice of treatment is strongly dependent on antibiotic resistance rates. In some countries, triple therapy with a proton-pump inhibitor, amoxicillin, and clarithromycin is still the best option, but eradication results fall short of what would be desired (90-95%) in countries with clarithromycin resistance >20%, bismuth-containing quadruple therapy, or nonbismuth sequential or concomitant therapies may then be the preferred option. Newer antibiotic regimens are awaited. Vaccination would be the best option, especially for developing countries, but little progress has been made in designing a vaccine.A considerable amount of work has been conducted over the last year assessing many issues around Helicobacter pylori eradication therapy. These focussed primarily on assessing the efficacy of current standard triple therapy and exploring new first-line treatments. There was also progress in investigating antibiotic resistance rates, and the rescue therapies required to deal with ensuing treatment failures. There has also been an evolution in the use of adjunctive therapies. This article will address the published literature over the last year pertaining to these topics. Triple TherapyNumerous studies over the last year have assessed the efficacy of standard triple therapy with amoxicillin, clarithromycin, and a proton-pump inhibitor for the eradication of H. pylori, which have been perceived to be in decline in recent years. One such study looked at cure rates reported in all published literature from Spain between 1997 and 2008 and found that while cure rates have in fact been stable over that period, they remain inadequate with a mean cure rate of 80% by intention-to-treat and 83% by per-protocol [1]. Similar results were obtained from a multicenter study in Japan that revealed an eradication rate of 80.7% with an incidence of adverse drug reactions of 4.4% [2]. Other studies have looked at whether the efficacy of triple therapy can be improved by prolonging the course of therapy. In China, a study of shorter regimens showed eradication rates of 76, 89, and 91% for 3-day, 5-day, and 7-day regimens, respectively [3]. Increasing efficacy by prolongation of therapy was also noted in Greek patients, with eradication rates of 74.5% for 7 days, 80.6% for 10 days, and 90.2% for 14 days of therapy [4]. Another study showed that efficacy could be maintained when lower doses of medications were given, which reduced costs and side effects with cure rates of 77.2% for 10 mg rabeprazole, 500 mg amoxicillin, and 250 mg clarithromycin vs 78.9% for the standard 20 mg, 1 g, and 500 mg doses of these drugs [5].Regardless of the type of therapy used, study from Canada showed widespread failure to comply with test and treat in up to 10% of cases and a failure to confirm eradication in 32% [6]. This illustrates that efficacious first-line therapy will always depend on adherence to guidelines by phy...

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How Well Is Heliobacter pylori Treated?

Cited by 6 publications

References 0 publications

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

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

Do We EradicateHelicobacter pyloriin Hospitalized Patients with Peptic Ulcer Disease?

Treatment of Helicobacter pylori infection 2012

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