Helicobacter pylori Eradication Rates among Patients Undergoing Endoscopy Remain Stagnant Despite Evolving Clinical...

Area of Science:

• Gastroenterology
• Infectious Diseases
• Oncology

Background:

• Helicobacter pylori infection is a primary risk factor for non-cardia gastric adenocarcinoma, a cancer with significant racial disparities in US mortality.
• Current guidelines recommend reviewing prior antibiotic use for H. pylori treatment, yet local resistance data are often lacking, and clarithromycin resistance is rising.
• The 2017 American College of Gastroenterology guidelines emphasize personalized H. pylori treatment based on antibiotic history.

Purpose of the Study:

• To evaluate the impact of prior antibiotic exposure on H. pylori eradication rates.
• To assess changes in H. pylori treatment practices and their association with eradication success.
• To determine if current treatment strategies align with guideline recommendations for H. pylori management.

Main Methods:

• Retrospective analysis of 477 patients diagnosed with H. pylori via upper endoscopy (EGD) between 2015 and 2019.
• Data collection included EGD findings, H. pylori diagnosis, treatment regimens, eradication testing, and records of prior macrolide and metronidazole use.
• Comparison of eradication rates based on previous antibiotic exposures and analysis of treatment practice shifts over time.

Main Results:

• Eradication testing rates increased from 35% in 2015 to 64% in 2019, with 50% of patients overall receiving testing.
• Treatment shifted from triple to quadruple therapy without a significant increase in successful eradication (overall 72%).
• No significant difference in eradication rates was observed based on prior antibiotic exposure (clarithromycin: 85%, metronidazole: 73%, no prior exposure: 86%).

Conclusions:

• Prior antibiotic exposure history did not significantly influence H. pylori eradication success in this cohort.
• Shifting to metronidazole-based quadruple therapy, a recommended first-line treatment, did not improve overall eradication rates.
• Alternative methods beyond querying antibiotic history are necessary to improve H. pylori eradication efficacy.