1212 H. pylori Breath Testing in an Academic Medical Center: Utilization and Treatment Outcomes

Abstract

INTRODUCTION: Helicobacter pylori is a major cause of stomach and duodenal ulcers According to the 2017 American College of Gastroenterology (ACG) Clinical Guidelines, only patients with active or past Peptic Ulcer Disease (PUD), low-grade MALT lymphoma, or history of endoscopically resected early gastric cancer should be tested for H. pyloriinfection. The breath test should be performed at least 4 weeks after stopping antibiotics and at least 2 weeks after stopping PPIs. The objective of this study was to determine whether the guidelines for the use of the breath test in an internal medicine physician practice were being followed. METHODS: We evaluated all 2016 patients in an academic Internal Medicine practice who had a BreathTek® Urea Breath Test for H. pylori in 2016. Patient files were reviewed through 2018 with respect to treatment and outcomes. RESULTS: An H. pylori breath test was performed in 257 patients (191 African-American (AA); 74%) and 66 non-AA). It was most likely used for diagnostic purposes (217/257 = 84%) and more likely to be ordered by a non-gastroenterologist (non-GI) (94% vs 69%; P < 0.001). Only 2 tests were for PUD; the majority were for Acid Reflux/Dyspepsia/GERD (48%), Abdominal Discomfort (33%), or Nausea/Vomiting/Recurrence of symptoms (12%). Of the 68 patients on a PPI, the gastroenterologists (GI) were more likely to comply with the guidelines of waiting to perform the test 2 weeks later as compared to the non-GI (48% vs 23%; P < 0.05). Of the 84 patients who were positive for H. pylori and were treated, 55 were cured with treatment, 22 were lost to follow up, and 7 were not cured with treatment (89% cure per protocol). The primary treatment was triple therapy (n = 77) with Clarithromycin/Amoxicillin (Metronidazole)/PPI. Seven patients were treated with quadruple therapy (triple plus bismuth). The percent of cured patients was similar between AA (87%) and non-AA (95%). Retreatment was successful in the 3 patients who received it. CONCLUSION: The majority of breath tests were for gastric/esophageal discomfort and did not meet the recommended criteria for the test. Significant numbers of providers in this study did not wait the recommended 2 weeks following PPI usage when ordering a breath test for H. pylori. Patients responded well to treatment with antibiotic and PPI therapy regardless of race. Thus, these studies suggest that educational interventions might be useful to increase compliance with the guidelines.