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Adherence to Helicobacter pylori Management Consensus in Clinical Practice at Two Tertiary Hospitals: A Large Cohort
Pudit Chinniyomwanich1, Puth Muangpaisarn2, Rapat Pittayanon1,3
1Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Background:
Many countries have launched Helicobacter pylori (HP) management guidelines to assist physicians, based on regional data. However, adherence is often assessed using questionnaires, which may not accurately reflect real-world practice. This study aimed to assess adherence to the Thailand Consensus on HP management through a retrospective chart review conducted at two tertiary hospitals in Thailand.
Materials And Methods:
This retrospective study was conducted at King Chulalongkorn Memorial Hospital (KCMH), located in the capital, and Phrapokklao Hospital (PPK), located in a province. Medical records of patients diagnosed with Helicobacter pylori (HP) infection via esophagogastroduodenoscopy (EGD) with a rapid urease test (RUT) between 2019 and 2021 were reviewed. Collected data included demographics, indications for HP testing, pre-EGD preparation, treatment regimens, and follow-up practices.
Results:
2,136 medical records were reviewed: 1,987 KCMH and 149 PPK. Most patients were Thai under universal health coverage. Pre-diagnostic preparation at KCMH showed 98.5% discontinued proton pump inhibitors (PPIs) ≥2 weeks, compared to 83.9% at PPK (p < 0.001). Antibiotic discontinuation ≥4 weeks was higher at KCMH (98.6% vs 95.3%, p = 0.009). For first-line, KCMH (74.6%) received PPI-based triple therapy for 14 days, while 77.5% at PPK received concomitant therapy. 78% at KCMH confirmed HP eradicate vs 44.1% at PPK (p < 0.001). Eradication rates were comparable (95.9% at PPK vs 89.4% at KCMH: p = 0.139).
Conclusion:
This study highlights suboptimal adherence to the Helicobacter pylori (HP) consensus in provincial hospitals in Thailand, suggesting that future guidelines should address healthcare limitations outside the capital to enhance the overall quality of national healthcare.
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