Optimal initiation of<i>Helicobacter pylori</i>eradication in patients with peptic ulcer bleeding

Yoon, Hyuk

doi:10.3748/wjg.v21.i8.2497

Cited by 8 publications

(11 citation statements)

References 26 publications

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“…In the present study of 152 patients diagnosed with H. pylori ‐associated PUD and treated with eradication therapy, 44% received post‐treatment testing to prove eradication. Our finding is similar to previously reported rates of post‐treatment testing rates of 30%‐40% . Understanding the factors that predict appropriate post‐treatment testing may help us to design and implement new strategies to ensure that appropriate follow‐up testing is performed.…”

Section: Discussionsupporting

confidence: 89%

“…Despite guidelines suggesting documentation of H. pylori eradication, discrepancies exist between recommended and actual practice in the management of H. pylori ‐associated PUD. 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%

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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: 89%

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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“…Bleeding peptic ulcer accounts for 75% of patients admitted to ED for peptic ulcer disease [148] and has different etiologies (ulcerogenic medications such as acetylsalicylic acid and NSAIDs, H. pylori infection, etc). H. pylori infection has a variable prevalence of 20-50% among patients with bleeding peptic ulcer in various countries, but its eradication is associated with a significant reduction in ulcer recurrence rate and rebleeding [66,[149][150][151].…”

Section: Antimicrobial Therapymentioning

confidence: 99%

Perforated and bleeding peptic ulcer: WSES guidelines

et al. 2020

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Background: Peptic ulcer disease is common with a lifetime prevalence in the general population of 5-10% and an incidence of 0.1-0.3% per year. Despite a sharp reduction in incidence and rates of hospital admission and mortality over the past 30 years, complications are still encountered in 10-20% of these patients. Peptic ulcer disease remains a significant healthcare problem, which can consume considerable financial resources. Management may involve various subspecialties including surgeons, gastroenterologists, and radiologists. Successful management of patients with complicated peptic ulcer (CPU) involves prompt recognition, resuscitation when required, appropriate antibiotic therapy, and timely surgical/radiological treatment. Methods: The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the board of the WSES to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the 5th WSES Congress, and for each statement, a consensus among the WSES panel of experts was reached. Conclusions: The population considered in these guidelines is adult patients with suspected complicated peptic ulcer disease. These guidelines present evidence-based international consensus statements on the management of complicated peptic ulcer from a collaboration of a panel of experts and are intended to improve the knowledge and the awareness of physicians around the world on this specific topic. We divided our work into the two main topics, bleeding and perforated peptic ulcer, and structured it into six main topics that cover the entire management process of patients with complicated peptic ulcer, from diagnosis at ED arrival to post-discharge antimicrobial therapy, to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.

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“…In a metaregression analysis, the infection rate was significantly higher when diagnostic testing was delayed until at least 4 weeks following the bleeding event, suggesting that retesting H. pylori at a later time in PUB patients with initially negative test results was necessary [9]. However, late diagnosis of H. pylori infection in PUB patients leads to significant number of those with H. pylori infection who did not receive eradication therapy [4]. Therefore, increasing the sensitivity of tests for early diagnosis of H. pylori infection during admission period of PUB is crucial.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, the importance of early diagnosis and eradication of H. pylori during admission period of patients with PUB has been further emphasized because the rate of recurrent PUB has been reduced with such strategy [3]. A recent study reported that up to 40% of PUB patients with H. pylori infection did not receive H. pylori eradication therapy and were lost to follow-up if diagnostic tests were performed after discharge [4]. Another study showed that less than 50% of patients with PUB received H. pylori testing and less than 10% had any H. pylori testing after discharge [5].…”

Section: Introductionmentioning

confidence: 99%

Early Diagnosis of Helicobacter pylori Infection in Vietnamese Patients with Acute Peptic Ulcer Bleeding: A Prospective Study

Quach

Luu

Hiyama

et al. 2017

Gastroenterology Research and Practice

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Aims. To investigate H. pylori infection rate and evaluate a combined set of tests for H. pylori diagnosis in Vietnamese patients with acute peptic ulcer bleeding (PUD). Methods. Consecutive patients with acute PUB were enrolled prospectively. Rapid urease test (RUT) with 3 biopsies was carried out randomly. Patients without RUT or with negative RUT received urea breath test (UBT) and serological and urinary H. pylori antibody tests. H. pylori was considered positive if RUT or any noninvasive test was positive. Patients were divided into group A (RUT plus noninvasive tests) and group B (only noninvasive tests). Results. The overall H. pylori infection rate was 94.2% (161/171). Groups A and B had no differences in demographic characteristics, bleeding severity, endoscopic findings, and proton pump inhibitor use. H. pylori-positive rate in group A was significantly higher than that in group B (98.2% versus 86.7%, p = 0.004). The positive rate of RUT was similar at each biopsy site but significantly increased if RUT results from 2 or 3 sites were combined (p < 0.05). Conclusions. H. pylori infection rate in Vietnamese patients with acute PUB is high. RUT is an excellent test if at least 2 biopsies are taken.

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Optimal initiation ofHelicobacter pylorieradication in patients with peptic ulcer bleeding

Abstract: Because many patients with PUB who were discharged before H. pylori infection status was confirmed lost an opportunity to receive ET, we should confirm H. pylori infection and start ET prior to discharge.

Cited by 8 publications

References 26 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

Perforated and bleeding peptic ulcer: WSES guidelines

Early Diagnosis of Helicobacter pylori Infection in Vietnamese Patients with Acute Peptic Ulcer Bleeding: A Prospective Study

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