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

Helicobacter pylori is the strongest risk factor for non-cardia gastric adenocarcinoma, the cancer with the greatest racial disparity in US cancer mortality. The 2017 American College of Gastroenterology guidelines recognized that local H pylori antibiotic resistance data are often unavailable in the United States, highlighted increasing clarithromycin resistance, and recommended that providers review previous antibiotic exposures before selection of an H pylori treatment regimen.

We analyzed a retrospective cohort of 477 patients with H pylori diagnosed on upper endoscopy (or esophagogastroduodenoscopy [EGD]) from 2015 to 2019. Clinical data abstracted included all EGD findings, H pylori diagnoses, treatments, eradication testing, and prior macrolide and metronidazole exposures.

Overall, eradication testing rates were low after index EGD, with 50% of the 477 patients receiving eradication testing after H pylori diagnosis although eradication testing rates increased from 35% in 2015 to 64% in 2019 (P < 0.0001). During this time period, H pylori treatment practice patterns shifted from triple to quadruple therapy without a corresponding increase in successful eradication, and overall, successful eradication was achieved in 72% of patients. After an initial H pylori diagnosis, 202 patients were treated, followed by completion of eradication testing. We found no significant differences in eradication rates based on prior antibiotic exposures; comparing H pylori eradication rates for previous macrolide treated with clarithromycin (85%), previous metronidazole treated with metronidazole (73%) versus no prior antibiotic exposure (86%).

Although guidelines suggest querying prior antibiotic exposures before selecting H pylori therapy, our findings emphasize that alternative methods to improve eradication rates may be important. Although practice patterns shifted to use more metronidazole-based therapy, as currently suggested as first-line H pylori therapy in the United States, this change was not associated with an overall improvement in eradication rates.