INTRODUCTION:
The 2017 American College of Gastroenterology Clinical guidelines advocate clarithromycin triple therapy (CTT) as first line H. Pylori (HP) treatment. CTT consists of a 14-day course of a proton pump inhibitor (PPI), clarithromycin, and amoxicillin or metronidazole. The national CTT eradication rate (ER) nears 80%. Many well-established factors affect treatment success including therapy duration, compliance, smoking, diabetes mellitus (DM), and local antibiotic resistance rates. Efficacy data on CTT in the Rio Grande Valley (RGV) has not been previously described. It is assumed that local resistance rates parallel those of our neighboring country due to proximity which may influence clinical practice. Aim is to determine the factors that affect biopsy-proven HP treatment failure.
METHODS:
A retrospective analysis of patients treated for HP in one RGV gastroenterology center between 2015 and 2018 was done. Eradication was defined by either a negative 13C Urea breath test or by a negative HP stool antigen test after treatment. ER was calculated for each regimen and compared against therapy duration, smoking, DM, health insurance status, and socioeconomic level; the latter determined by patient zip codes. We calculated raw ORs (95% CI) and adjusted with Cox and binary logistic regression.
RESULTS:
Of 544 patients, 71% (384) were females and 97% (526) were Hispanic. Nonsmokers were 79% (425) and diabetics were 32% (174). In total, 56% (305) received CTT and 44% (239) received quadruple therapy (QT) (ie., Tetracycline, metronidazole, bismuth, any PPI). ER was 66% for CTT and 62% for QT. Regarding both therapies, no treatment failure difference was found (P = 0.62) at 10 days, however, treatment failure decreased with 14-day therapy (P < 0.001). Regarding health insurance, 84% (452) had private, 13% (72) had government-issued, and 3% (16) were self-pay. Cox regression found no differences in treatment type. Logistic regression found that females OR 2.25 (95% CI 1.4, 3.5, P < 0.001), income <$40,000/year OR 1.78 (95% CI: 1.1, 2.8, P = 0.013), and smoking OR 1.6 (95% CI 1.03, 2.6, P = 0.034) negatively affected eradication.
CONCLUSION:
HP therapy efficacy was suboptimal, however, 14-day therapy improved treatment failure. More females were affected with HP. Factors negatively affecting eradication were female gender, smoking, and income <$40,000/year. Further studies are required to determine the role of patient education, HP local antibiotic resistance patterns, and physician practice on HP eradication.
