Clinical Characteristics and Treatment Pathway of Patients Treated with Helicobacter pylori Infection-A Single Center Cohort Study Using Common Data Model

Abstract

Background/Aims: Changing trends in the <i>Helicobacter pylori</i> (<i>H. pylori</i>) eradication protocol have not been investigated after the publication of the third-revised Korean guideline in 2013. We aimed to analyze the clinical characteristics of <i>H. pylori</i>-infected patients alongside their treatment protocols using a common data model (CDM).Materials and Methods: A 16-year electronic health record (of 1,689,604 patients from 2004 to 2019) was converted into a CDM in Kangdong Sacred Heart Hospital. We extracted records of patients who underwent the rapid urease test or serum anti-<i>H. pylori</i> IgG assay. The treatment protocols were visualized using a sunburst plot. We investigated the clinical characteristics and medication history of patients who underwent a urea breath test after clarithromycin-based eradication therapy.Results: Out of 29,458 patients tested for <i>H. pylori</i> infection, 7,647 received a treatment protocol. Among them, 72.5% received a 7~14 days protocol comprising a proton pump inhibitor (PPI), amoxicillin, and clarithromycin. The proportion of patients treated with the first-line protocol (PPI, bismuth, tetracycline, and metronidazole) slightly increased from 1.9% (before 2014) to 3.3% (after 2014) (P<0.001). The percentages of patients with of previous exposure to macrolides (14.7% vs. 5.5%, P<0.001) or amoxicillin (10.6% vs. 7.3%, P=0.006) were higher in patients with previous clarithromycin-based eradication failure.Conclusions: The <i>H. pylori</i> treatment protocol was not significantly modified despite the updates in the clinical guideline. There was only 1.4 percentage point increase in bismuth-based quadruple therapy as first-line eradication therapy even after the announcement of revised Korean guideline in 2013.