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Author Spotlight: Detection and Treatment of Helicobacter pylori Infection
Published on: July 28, 2023
Low adherence to Helicobacter pylori testing in hospitalized patients with bleeding peptic ulcer disease
John J Kim1, John S Lee, Snorri Olafsson
1Loma Linda University Global Health Institute, Loma Linda, CA, USA; Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China.
Insights
Less than half of patients with bleeding ulcers received Helicobacter pylori (H. pylori) testing, and under a third had direct testing. Biopsy of gastric ulcers increased direct H. pylori testing rates, indicating a need for improved testing strategies.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Clinical Quality Improvement
Background:
- Society guidelines recommend Helicobacter pylori (H. pylori) testing for bleeding ulcers.
- H. pylori testing is a key quality indicator in managing gastrointestinal bleeding.
- This study investigates H. pylori testing rates and predictors in bleeding ulcer patients.
Purpose of the Study:
- To determine the proportion of bleeding ulcer patients who underwent H. pylori testing.
- To identify factors associated with H. pylori testing in this population.
- To evaluate the types of H. pylori testing performed.
Main Methods:
- Retrospective analysis of 330 hospitalized patients with endoscopically documented bleeding ulcers (10/2004-5/2011).
- Assessed direct H. pylori testing (histology, rapid urease, breath, stool antigen) and any H. pylori testing (including serology).
- Multivariate analysis identified predictors of direct H. pylori testing.
Main Results:
- Only 32% (105/330) received direct H. pylori testing; an additional 16% (52/330) had serologic testing.
- Direct testing occurred during the index hospitalization in 93% of cases.
- Biopsy of a gastric ulcer significantly predicted direct H. pylori testing (OR=5.1, p<.0001).
Conclusions:
- Less than half of hospitalized bleeding ulcer patients received H. pylori testing.
- Direct H. pylori testing rates remain suboptimal, with most testing being biopsy-based during initial endoscopy.
- Enhanced strategies are necessary to improve H. pylori testing rates and patient outcomes.
Background:
Helicobacter pylori (H. pylori) testing in patients with bleeding ulcers is recommended by society guidelines and considered a quality indicator. The aim of the study is to examine the proportion of patients with bleeding ulcers who had H. pylori testing and identify predictors associated with H. pylori testing.
Materials And Methods:
Consecutive hospitalized patients with bleeding ulcers documented endoscopically at a single center from 10/2004-5/2011 were identified retrospectively from an endoscopy database. The proportion of patients undergoing direct H. pylori testing (histology, rapid urease test, breath test or stool antigen) and any H. pylori testing (direct or serologic) were determined.
Results:
Among 330 patients with bleeding ulcers, 105 (32%, 95% CI 27-37%) underwent direct testing and another 52 (16%, 95% CI 12-20%) had serologic testing during a median follow-up of 9 months (range, 0-86). H. pylori testing occurred at the index hospitalization in 146 (93%) of the 157 patients tested. Among the 105 patients who had direct H. pylori testing, 90 (86%) had biopsy-based testing during the initial endoscopy. On multivariate analysis, undergoing biopsy of a gastric ulcer was strongly associated with having direct H. pylori testing performed (OR = 5.1, 95% CI 2.3-11.5; p < .0001).
Conclusions:
Among patients hospitalized with bleeding ulcers, less than half received H. pylori testing and less than a third received the more accurate direct testing. Most of the direct H. pylori testing was biopsy-based with very few being tested after the index hospitalization. Efforts to increase H. pylori testing in patients with bleeding ulcers are needed to improve outcomes.
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