S1607 The Efficacy of Bismuth Based Quadruple Therapy Compared With Clarithromycin-Based Triple Therapy for Helicobacter pylori in a Predominantly Hispanic Population: A Retrospective Cohort Study

Abstract

Introduction: Helicobacter pylori has a prevalence of approximately 35% in the United States. Infection rates and antibiotic resistance are reported to be higher in immigrants from endemic areas such as Latin America. Clarithromycin based triple therapy had been used as the first line treatment; however, the updated ACG H. pylori guidelines in 2017 recommends bismuth based quadruple therapy as the first line treatment in a population with suspected clarithromycin resistance. The aim of this study was to evaluate the effectiveness of bismuth quadruple therapy compared with clarithromycin triple therapy in a predominantly Hispanic population on the US- Mexico border, as well as to assess the impact of insurance status and the 2017 ACG guidelines on the choice of treatment regimen. Methods: A retrospective cohort study of adult patients with H. pylori infection treated with clarithromycin triple therapy or bismuth quadruple therapy at a tertiary care county hospital on the US-Mexico border from January 2009 to March 2022 was conducted. Patients with unknown treatment regimens or an absence of an eradication test were excluded from the analysis. A logistic regression model adjusting for propensity scores using the inverse probability treatment weighting method was used to determine the relationship between eradication status and the treatment regimen. The analyses were adjusted for, age, gender, ethnicity, insurance, diabetes, smoking, illicit drug use, and PPI use. Results: A total of 938 patients were included, 201 patients (21.4%) in the quadruple regimen group and 737 patients (78.6%) in the triple regimen group. Mean age was 51 years, female (70.8%), Hispanic (90.4%), and non-insured patients (29.4%). The H. pylori eradication rate with quadruple therapy was significantly higher compared with triple therapy (91.5% vs 83.2% P=0.004) in unadjusted analysis and after adjusting for propensity scores (OR 2.43; 95% CI: [1.38 - 4.27], P=0.002). Following the 2017 ACG guidelines, the rate of using quadruple as the first line therapy increased from 11.1% to 24.6% (P< .0001). Furthermore, quadruple regimen therapy was more likely to be prescribed for insured (79.1%) compared with non-insured (20.9%) patients (P< 0.001) (Table). Conclusion: In a predominantly Hispanic population, bismuth quadruple therapy is more effective in H. pylori eradication compared with clarithromycin triple regimen. However, insurance status seems to influence the choice of recommended regimen in this high-risk population. Table 1. - Comparisons of characteristics between initial treatment regimens Initial Treatment Regimens Factor Bismuth Quadruple Clarithromycin Triple P-value N 201 737 Age (years) 0.017 Age at testing, mean (SD) 53.92 (13.44) 51.33 (13.66) Gender 0.080 Female 132 (65.67%) 532 (72.18%) Male 69 (34.33%) 205 (27.82%) Ethnicity 0.54 Non-Hispanic 16 (7.96%) 69 (9.36%) Hispanic 185 (92.04%) 668 (90.64%) Insurance status 0.003 No 42 (20.90%) 234 (31.75%) Yes 159 (79.10%) 503 (68.25%) Diabetes 0.93 No 151 (75.12%) 550 (74.63%) Yes 50 (24.88%) 187 (25.37%) Smoking history 0.76 No 165 (82.09%) 594 (80.82%) Yes 36 (17.91%) 141 (19.18%) Illicit drug use 0.58 No 195 (97.50%) 718 (98.09%) Yes 5 (2.50%) 14 (1.91%) PPI use before diagnosis 1.00 No 149 (75.63%) 547 (75.66%) Yes 48 (24.37%) 176 (24.34%) Type of eradication test < 0.001 Endoscopic biopsy 25 (12.44%) 69 (9.39%) Stool test 120 (59.70%) 302 (41.09%) Breath test 56 (27.86%) 364 (49.52%) Result of eradication test 0.004 Positive (failure of eradication) 17 (8.46%) 123 (16.73%) Negative (successful eradication) 184 (91.54%) 612 (83.27%) Gastric cancer 1.00 No 198 (99.50%) 725 (99.04%) Yes 1 (0.50%) 7 (0.96%) SD: standard deviation; PPI: proton pump inhibitor.