Treating Veterans for Helicobacter Pylori Infection: Retrospective Evaluation of Long-term Outcomes

Abstract

Purpose This study documented the long-term outcomes of patients treated in a pharmacist-managed Helicobacter pylori (HP) clinic. Background An HP clinic was created in 1996 at a Veterans Affairs (VA) hospital. Patients received clarithromycin/amoxicillin-based therapy according to the clinic protocol. Clarithromycin use was restricted to treatment of HP infection. Metronidazole was used instead of amoxicillin in penicillin allergic patients. Results at 1 year showed that 53% of the patients were able to discontinue chronic heartburn therapy. Outcomes beyond 1 year were not established. Methods The electronic records of patients treated at the HP clinic from June 1996 to March 2001 were evaluated. Patients with at least 2 years of follow-up information were included. Baseline demographic and long-term outcome data were collected. Discontinuation rate, failure rate, and need for retreatment were evaluated. Results Of 229 patients treated during the period studied, at least 2 years of data was available for 198 individuals. Of these, 177 were men and 21 were women. Three of the 198 patients (1.5%) were unable to complete antibiotic therapy. Five patients (2.5%), two of them women, failed an initial course to eradicate HP. After treatment with bismuth-based therapy, four of these five patients showed documented eradication of infection. Forty-four percent of patients were off chronic therapy at the time of last review. Conclusions A pharmacist-managed HP treatment clinic can facilitate discontinuation of chronic acid suppressive therapy in more than a third of patients. A low treatment failure rate — below the national average for clarithromycin-based regimens — was found in our population.