Three studies at Digestive Disease Week 2018 (June 2-5, 2018, Washington, DC) explored challenges in effective management of infection with Helicobacter pylori. Click through the slides above for highlights of:
Research to develop/validate a scoring system that will stratify H. pylori risk, help limit gastric biopsies
A study that indicates very low use of eradication testing for patients treated for H. pylori
Research that identifies patterns of international H. pylori treatment failure and antibiotic resistance
Development and validation of a scoring system to identify patients with Helicobacter pylori infection.
Helicobacter pylori Diagnosis: Is There a Better Way? Multiple non-invasive tests exist for diagnosing H. pylori but many patients are still referred for invasive upper endoscopy. Moreover yield is low from gastric biopsies done for vague upper GI symptoms. This new study was designed to develop and validate a scoring system to identify H. pylori and avoid invasive diagnostics.
Easy-to-Use Score Created that IDs Patients with H. pylori. Clinical score was created with 5 factors linked to increased Hp risk. The clinical score can help triage triage patients with high probability of Hp to noninvasive testing while the total score can help limit gastric biopsies to patients with a high probability of Hp.
Low rates of H. pylori eradication testing and cure rates in usual care.
Test of Cure for H. pylori: We need to know more. Hp post-treatment antibiotic resistance is common. Treatment guidelines recommend a test of cure in all patients treated for Hp but data are scant.
First-Line Treatment Failure <20% yet Eradication Testing Low. Eradication testing at 1 year was only 35% among those with peptic ulcer disease and 36% among those with confirmed gastric/duodenal ulcers. Testing rates were similarly low for GI and non-GI providers. Need interventions to optimize eradication failure and strategies to optimize successful treatment.
Helicobacter pylori antibiotic resistance patterns among non-US born and US-born patients from an ethnically diverse population who failed first-line therapy.
Does Antibiotic Resistance in H pylori Correlate with Country of Origin? The rise in antibiotic resistance for treatment of Hp is global; a case series of patients with treatment failure evaluated gastric biopsies and assessed minimum inhibitory concentrations of antibiotics used to treat.
Multi-Drug Resistance Rates High, Vary by Country of Origin. Multidrug resistance was high and half of subjects had resistance to three or more antibiotics; rates varied by country of origin. Of note US-born patients are likely to fail quinolone salvage treatment.
Take Home Points
Single center study developed and validated an Hp scoring system to limit gastric biopsies and triage patients with a high probability of Hp to noninvasive testing
Single center study found over 20% first-line treatment failure for Hp, yet only 35% eradication testing one year after treatment
Single center case series found US-born patients with Hp treatment failure are likely to fail quinolone salvage therapy; retreatment of US and non-US born patients should favor quadruple therapy (tetracycline, PPI, metronidazole, bismuth)