Helicobacter pylori eradication: are we really all equal? A controlled study in native and immigrant population

Area of Science:

• Gastroenterology
• Infectious Diseases
• Public Health

Background:

• Low socioeconomic status, common among immigrants, is linked to higher H. pylori infection rates.
• Italy's economic shift has increased demand for unskilled labor, a sector with a high immigrant presence.
• Helicobacter pylori (H. pylori) infection is a significant global health concern, often associated with peptic ulcer disease (PUD).

Purpose of the Study:

• To compare the efficacy of a 7-day triple therapy for H. pylori eradication between immigrant and Italian patients.
• To assess and compare the prevalence of peptic ulcer disease (PUD) in these two patient groups.
• To investigate factors influencing H. pylori eradication rates in immigrant populations residing in Italy.

Main Methods:

• Recruitment of 116 immigrant and 112 Italian H. pylori-infected patients between 2007-2008.
• Utilized (13)C-urea breath test ((13)C-UBT) and endoscopy with biopsies for diagnosis and eradication assessment.
• Administered a standard 7-day triple therapy, with eradication confirmed 8 weeks post-treatment via (13)C-UBT.

Main Results:

• Significant differences observed between groups in median age, PUD prevalence, and smoking status (p < 0.01).
• H. pylori eradication rate (ITT analysis) was 70% for Italians versus 48.3% for immigrants (p < 0.01).
• Multivariate analysis indicated immigrants had an adjusted odds ratio of 2.14 for treatment failure (p = 0.03).

Conclusions:

• The standard 7-day triple therapy demonstrated significantly lower efficacy in immigrant patients compared to native Italians.
• Immigrant status was independently associated with a higher likelihood of H. pylori treatment failure.
• Further research is warranted to understand and address the reduced treatment effectiveness in immigrant populations.