Finally! Some Overdue Helicobacter pylori Data From the United States

Abstract

Introduction: Declining Helicobacter pylori (H. pylori) eradication rates worldwide related to antibiotic resistance have recently prompted many authorities (including the ACG) to recommend a switch from standard triple to bismuth-based quadruple for first line therapy. A major caveat in the development of the ACG 2017 guidelines was a paucity of U.S. eradication data over the last decade. We therefore examined the efficacy of various H. pylori eradication regimens in the Rhode Island population Methods: Electronic medical records and pathology databases of the major RI teaching hospitals were searched to identify all patients diagnosed with H. pylori infection by pathology, urea breath or stool antigen testing for the years 2015- 2017. From these records the demographics, diagnostic test utilized, treatment regimen prescribed and test of cure (TOC) result (if any) were extracted. Finally, for those patients who were treated and had a TOC, eradication rates were calculated for commonly used regimens, and compared by ANOVA Results: 1710 patients were identified (64% female). 825 (46%) were diagnosed by breath testing, 755 (42%) by biopsy, and 191 (12%) by stool antigen. Full eradication results were obtained on 1101 patients where treatment was documented and TOC performed. 7 different treatment regimens were used: Quadruple (64%), standard triple (PPI, Clarithromycin, and Amoxicillin) (25%). In 5%, treatment was with Quadruple, with Doxycycline instead of Tetracycline, and in 6% of cases other miscellaneous regimens were given. Eradication rates are shown in the table and figure, demonstrating overall superiority of quadruple (85% eradication overall) over triple therapy (75%, P= 0.01), quadruple 14 vs triple 14 days (87% vs 79%, P= 0.006), quadruple 10 vs triple 10 77% vs 67%, P= 0.12, Furthermore, increased length of therapy was statistically significant (quadruple 14 vs 10, 87% vs 77%, P=0.04), triple 10 vs 14 (79% vs 67%, P=0.03), No significant trends were noted across the 3 years. Finally, substituting doxycycline for tetracycline resulted in lower eradication rates (85% vs 67%, P= 0.005) Conclusion: Within the RI population, quadruple therapy is superior to triple therapy, likely related to clarithromycin resistance. Longer 14 day therapy is better than 10 day. Doxycycline is inferior in quadruple therapy. Though uncontrolled and retrospective, our finding in large numbers of cases strongly support the current ACG and international guidelines advising 14 day bismuth quadruple therapy1059_A Figure 1 No Caption available.1059_B Figure 2 No Caption available.