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

Abstract

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.

Role of the Gastric Microbiome in Gastric Cancer: From Carcinogenesis to Treatment

“…However, only a small proportion of patients with H. pylori infection or who use NSAIDs progress to peptic ulcer disease, suggesting that decreased mucosal resistance to bacterial virulence factors and drug toxicity contribute to its pathogenesis (Lanas and Chan, 2017). H. pylori eradication therapy was shown to reduce the rate of recurrence (Tomita et al, 2002;Feder et al, 2018). A matrix-assisted laser desorption ionization time-of-flight mass spectrometry analysis showed that non-H. pylori bacteria were more abundant in patients with non-ulcer dyspepsia than in those with gastric ulcers, and the predominant non-H. pylori bacteria in H. pylori-positive patients were Streptococcus, Neisseria, Rothia, and Staphylococcus (Hu et al, 2012).…”

Increasing Testing for Helicobacter pylori Infection to Improve Quality of Patient Care

“…They have performed a thorough investigation of factors associated with the failure to test for the presence of H pylori in patients admitted with GI bleeding in the setting of PUD. Given previously reported data, 6 their finding that nearly 20% of patients admitted for bleeding PUD were not tested for H pylori within 60 days of index endoscopy is alarming but not surprising. Several predictors were identified, including endoscopy in the intensive care unit and coagulopathy.…”

“…4,5 Nonetheless, prior studies have documented low adherence to the test, treat, and confirm eradication paradigm. 6 Furthermore, antibiotic resistance is increasing 7 and knowledge of resistance patterns is seldom available. 8 In this context, the recent article by Hung et al 9 in this issue of Clinical Gastroenterology and Hepatology is particularly relevant.…”

“…As others have shown, gastroenterologists have awareness of optimal treatment approaches for PUD, 12 and gastroenterologist involvement results in improved guideline adherence relative to other specialities. 6 Although disappointing, in many ways the data from Hung et al 9 highlight an opportunity for improvement. Particularly because the management of H pylori-associated PUD represents a continuous episode of care, (an algorithmic approach jointly undertaken and shared by gastroenterologists), inpatient teams and outpatient practitioners is critical for improving quality.…”

Efficacy and safety of eradication therapy for elderly patients with helicobacter pylori infection

“…H. pylori is known to cause chronic gastritis, gastric and duodenal ulcers, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue (MALT) lymphomas. [4–6] In addition to symptomatic treatment, H. pylori eradication also appears to reduce the risk of gastric cancer, [7] especially metachronous gastric cancer, [8] and enhance gastric corpus atrophy grade improvement from baseline. [9] Therefore, all individuals with evidence of active H. pylori infection should be offered with eradication therapy in the absence of screening programs for asymptomatic cases.…”