A Single Center Study on Guideline Adherence to H. pylori Testing

Abstract

Introduction: It is well documented that PPI therapy decreases the sensitivity of all common methods of testing for H. pylori infection. This leads to decreased detection of colonization in patients hospitalized for GI bleeding, so routine follow up and re-testing is indicated 1-2 weeks after the withdrawal of PPI therapy. The aim of this study is to evaluate how often adequate follow up occurs in patients who were tested for H. pylori infection by EGD with biopsy during hospitalization for GI bleeding. Methods: A chart review of 240 patients admitted to a large suburban community hospital from January 2017 to April 2018 was conducted in search of individuals whose clinical course met the following criteria: patients had to have an ICD 10 code related to GI bleeding, been on PPI therapy for at least 2.5 hours prior to EGD with biopsy, survived to discharge, and been referred to a provider within the hospital's network. 36 patients met the criteria and we mathematically determined the proportion of patients who received adequate follow up based on records obtained from the outpatient providers. Results: Of the 36 patients included, 6 (16.7%) patients received adequate follow up. 8 (22.2%) were positive for H. pylori infection and of these patients, only 3 (37.5%) received treatment. Of the 28 patients with a negative test as an inpatient, only 3 (10.7%) had any record of ever being retested. Conclusion: The prevalence of H. pylori infection of the adult population in the Western world is estimated to be about 45%, however, studies have shown a prevalence of greater than 70% in patients treated for GI bleeding. Using a modest estimate of 45%, it is likely that several cases of H. pylori were not detected in this study, and most patients were never retested. The most common reason for not retesting was patient non-compliance, 50% of patients never returned for follow up. While patient non-compliance will always be a barrier to delivery of care, improved patient education on the importance of follow up would curb this issue. Of the 8 patients who tested positive for H. pylori, the 3 who sought further evaluation were treated and retested for eradication. Failure to detect H. pylori infection in patients with GI bleeding leads to further episodes of re-bleeding, and thus increased morbidity and mortality as well as increased healthcare costs. More must be done to ensure retesting in as many patients as possible. We are continuing this study across other healthcare networks for more data.