Evaluation of Posttreatment Eradication Testing Following Helicobacter pylori Therapy

In 2024, the American College of Gastroenterology updated its guidelines for Helicobacter pylori and now recommends utilizing optimized bismuth quadruple therapy in treatment naïve patients due to a rise in resistance in clarithromycin and levofloxacin therapies. It also emphasizes the importance of posttreatment eradication 4 weeks after treatment has been completed to confirm the infection was successfully eradicated. The authors' goal was to evaluate the rate and frequency of eradication testing to identify if there were opportunities to optimize therapy.

This retrospective cohort study included adult patients of Kaiser Permanente Georgia who had completed H pylori treatment from August 31, 2024, to August 31, 2025. The primary objective of this study was to determine whether eradication testing was completed within the appropriate time frame, if the infection was successfully eradicated, and whether testing was performed. The secondary outcome identified which treatment regimens were being utilized and evaluated potential barriers to therapy, including adherence and allergy-related issues.

This cohort included 51 patients, with 54 confirmed cases of H pylori. Eradication testing was performed in 33 cases (61%) overall, with 27 cases (50%) completed within the designated time frame. Testing was not completed in 21 cases (39%), and 7 cases (13%) were completed but outside the required time frame.

Eradication testing was not completed in nearly half (39%) of this cohort, and clarithromycin triple therapy continued to be frequently utilized despite recent guideline changes, suggesting an opportunity for practitioner education and improved patient outcomes.