S1362 Strategies for Testing for Helicobacter pylori: A Quality Project

Abstract

INTRODUCTION: Helicobacter pylori (HP) testing and treatment is complicated but essential in caring for gastroenterology (GI) patients. To improve testing completion and outcomes in our practice, we analyzed the test ordering habits of providers and overall compliance of patients to determine the most effective means of testing for HP, with particular focus on testing for eradication. METHODS: Our electronic medical record was queried during the time period of August 1, 2018 to September 30, 2019 for patients tested for HP via endoscopic biopsy (BX), stool antigen (Ag), and/or urea breath test (UBT) by GI providers. This data was compiled and analyzed, particularly looking for rates of eradication and retesting. RESULTS: There were 1607 unique patients with 1784 HP tests ordered during the time period – 18.4% positive, 72.4% negative, and 9.1% without result. BX accounted for the majority of tests (66.8%) followed by UBT (17.7%) and Ag (15.5%) (Table 1). Of the BX orders, 17.7% were positive, 81.1% were negative, and 1.2% did not result (Table 1). Regarding non-invasive testing, UBT were more commonly completed than Ag (93.0% vs 54.2%, respectively). BX were also the most common first-test for HP accounting for 75.0% of first-tests compared to Ag (14.0%) and UBT (11.0%). When patients had a second test ordered, 37.4% were BX, 26.6% were Ag, and 36.0% were UBT. Of the 305 initially positive for HP, 74.4% did not complete confirmatory testing for eradication, 19.0% were negative on subsequent testing, and 6.6% remained positive (Table 2). Of all 78 patients who were successfully tested for eradication, 56 patients (71.8%) had cleared the infection on their first re-test. CONCLUSION: Our data reveal variability of testing strategies and compliance among patients and various tests. Overall, there are a large number of patients that do not complete testing for eradication following diagnosis of HP. In particular, a large number of Ag orders remain incomplete, possibly due to the inconvenience of providing a stool sample. UBT orders have a much greater completion rate possibly due to our in-office scheduling and breath-testing. The majority of patients did not complete testing for eradication, but those who did showed a high likelihood of clearing the infection. Interventions to improve our model might be standardizing UBT as a post-treatment eradication study. A better understanding of test characteristics and patient factors can help improve compliance and eradication of HP.Table 1Table 2