The High Incidence of Treatment Failure In Eradicating Helicobacter pylori Infection in Individuals with Intellectual Disabilities and Developmental Delay (IDDD) from Long-Term Care Facility

Abstract

Purpose:Helicobacter pylori (H. pylori) infection is a major cause of chronic gastritis and peptic ulcer disease and is considered a risk factor for gastric mucosa-associated lymphoid tissue (MALT) lymphoma. According to the Maastricht III consensus report H. pylori eradication is recommended for patients with gastroduodenal ulcer disease, atrophic gastritis, and MALT lymphoma. However treatment is not successful in 10-35% of patients, with failure to eradicate H. pylori infection occurring for several reasons, including non-compliance to therapy and antibiotic resistance. While most studies have been done in mentally healthy individuals, there is limited data on the eradication rates in institutionalized individuals with intellectual disabilities and developmental delay (IDDD). We have previously demonstrated a higher incidence of H. pylori infection in individuals with IDDD. The purpose of this study was to evaluate the eradication rates among these patients compared to a general reference population. Methods: Between 2005 and 2012, 24 individuals living in a long-term state facility for IDDD underwent upper endoscopy for various indications by a group of endoscopists. During the same time period 7,012 patients underwent upper endoscopy at an outpatient center by the same group of endoscopists located in the same city and were considered the reference population. Among patients with IDDD, 20 (83%) were H. pylori positive, while 840 (12%) of patients from the reference population were H. pylori positive. Patients were treated with clarithromycin 500 mg PO BID and amoxicillin 1,000 mg PO BID for 14 days and omeprazole 20 mg PO BID for 14 days, then daily for 14 days. H. pylori eradication was confirmed via C13 breath test or stool H. pylori antigen. Results: The mean age of the IDDD and reference group that was H. pylori positive was 58 and 59 years, respectively. There were 40% and 60% African Americans, respectively, in each group. Among patients with IDDD, H. pylori was eradicated in 15 (out of 24) patients (60%) compared to 756 (out of 840) patients (90%) in the reference group (p<0.01). It was also observed that 80% of all H. pylori-positive IDDD patients were treated with antibiotics for periodontal disease. Conclusion: Our study has identified patients with IDDD at high risk in failing treatment for eradicating H. pylori infection. Antibiotic resistance and compliance as well as other factors such as re-infection because of the high prevalence of H. pylori among these patients may be significant contributing factors. Alternative treatment regimens should be considered in this patient population along with routine confirmation of eradication in order to mitigate the adverse consequence of chronic H. pylori infections.