Ten-Year Trends in First- and Second-Line Helicobacter pylori Eradication Rates at a Regional Hospital in Japan

Helicobacter pylori (H. pylori) infection is a major risk factor for gastric cancer, and successful eradication reduces long-term cancer incidence. Since national insurance coverage expanded in Japan in 2013, to include H. pylori-positive gastritis, eradication therapy has become widely accessible; however, outcomes may vary with antimicrobial resistance, evolving treatment regimens, and regional prescribing patterns. We investigated 10-year trends in eradication efficacy at a regional hospital in Japan.

This retrospective observational study included all patients who underwent first- or second-line H. pylori eradication therapy in our department between 2015 and 2024. Clinical characteristics, treatment regimens, and post-treatment test results were extracted from medical records. Annual success rates were assessed by intention-to-treat (ITT) and per-protocol (PP) analyses and evaluated using binomial generalized linear models, with a descriptive linear regression. Regimen selection and institutional clarithromycin utilization were also assessed for temporal trends.

Among 1,246 patients (1,126 first-line; 120 second-line), first-line eradication rates were stable in ITT analyses, with a modest upward trend in PP analyses. Second-line eradication rates remained consistently high without a significant temporal trend. Vonoprazan-based regimens became predominant, while institutional clarithromycin utilization declined.

Over the past decade, first-line H. pylori eradication efficacy remained stable in ITT analyses with modest improvement in PP analyses, while second-line therapy maintained high performance. The widespread establishment of vonoprazan-based regimens likely ensured stable efficacy, with a plausible additional contribution from declining clarithromycin use at the regional level. These findings provide insight into long-term, real-world eradication trends and may help inform treatment strategies in similar clinical settings.