Low Rates of Retesting for Eradication of Helicobacter pylori Infection After Treatment in the Veterans Health Administration

Abstract

Expert consensus mandates retesting for eradication of Helicobacter pylori infection after treatment, but it is not clear how many patients are actually retested. We evaluated factors associated with retesting for Hpylori in a large, nationwide cohort. We performed a retrospective cohort study of patients with Hpylori infection (detected by urea breath test, stool antigen, or pathology) who were prescribed an eradication regimen from January 1, 1994 through December 31, 2018 within the Veterans Health Administration (VHA). We collected data on demographic features, smoking history, socioeconomic status, facility poverty level and academic status, and provider specialties and professions. The primary outcome was retesting for eradication. Statistical analyses included mixed-effects logistic regression. Of 27,185 patients prescribed an Hpylori eradication regimen, 6486 patients (23.9%) were retested. Among 7623 patients for whom we could identify the provider who ordered the test, 2663 patients (34.9%) received the order from a gastroenterological provider. Female sex (odds ratio, 1.22; 95% CI, 1.08-1.38; P = .002) and history of smoking (odds ratio, 1.24; 95% CI, 1.15-1.33; P < .001) were patient factors associated with retesting. There was an interaction between method of initial diagnosis of Hpylori infection and provider who ordered the initialtest (P < .001). There was significant variation in rates of retesting among VHA facilities (P < .001). In an analysis of data from a VHA cohort of patients with Hpylori infection, we found low rates of retesting after eradication treatment. There is significant variation in rates of retesting among VHA facilities. Hpylori testing is ordered by nongastroenterology specialists two-thirds of the time. Confirming eradication of Hpylori is mandatory and widespread quality assurance protocols are needed.