Current status of Helicobacter pylori eradication and risk factors for eradication failure

Abstract

BACKGROUND The Helicobacter pylori ( H. pylori ) eradication rate is decreasing in the general population of China. AIM To evaluate the H. pylori eradication status in real-world clinical practice and to explore factors related to eradication failure. METHODS Patients with H. pylori infection who were treated with standard 14-d quadruple therapy and received a test of cure at a provincial medical institution between June 2018 and May 2019 were enrolled. Demographic and clinical data were recorded. Eradication rates were calculated and compared between regimens and subgroups. Multivariate analysis was performed to identify predictors of eradication failure. RESULTS Of 2610 patients enrolled, eradication was successful in 1999 (76.6%) patients. Amoxicillin-containing quadruple regimens showed a higher eradication rate than other quadruple therapy regimens (83.0% vs 69.0%, P < 0.001). The quadruple therapy containing amoxicillin plus clarithromycin achieved the highest eradication rate (83.5%). Primary therapy had a higher eradication rate than rescue therapy (78.3% vs 66.5%, P < 0.001). In rescue therapy, the amoxicillin- and furazolidone-containing regimens achieved the highest eradication rate (80.8%). Esomeprazole-containing regimens showed a higher eradication rate than those containing other proton pump inhibitors (81.8% vs 74.9%, P = 0.001). Multivariate regression analysis found that older age, prior therapy, and use of omeprazole or pantoprazole were associated with an increased risk of eradication failure. CONCLUSION The total eradication rate is 76.6%. Amoxicillin-containing regimens are superior to other regimens. Age, prior therapy, and use of omeprazole or pantoprazole are independent risk factors for eradication failure.

Implementation of WeChat‐based patient–doctor interaction in the management of Helicobacter pylori infection: A propensity score matching analysis

“…Considering an increasing failure of treatment to eradicate H. pylori , 14‐day quadruple therapy has been recommended based on the recent consensuses and guidelines. A study conducted at a provincial medical institution in China documented that quadruple therapies, including amoxicillin and clarithromycin, achieved the highest eradication rates compared with other standard 14‐day quadruple therapies for primary H. pylori eradication 19 . As this therapeutic regimen was sufficiently effective in our clinical population, it is not surprising that an enhanced compliance intervention did not further improve outcomes.…”

The effect of previous eradication failure on antibiotic resistance of Helicobacter pylori: A retrospective study over 8 years in Beijing

“…Although not included in our study, furazolidone has low antibiotic resistance rate against H . pylori in China according to published data 37–39 . The bismuth‐quadruple therapy containing AMX plus furazolidone could achieve an eradication rate of more than 80% in both first‐line and rescue therapy, which was better than other traditional therapies 37,40 .…”

“…pylori in China according to published data 37–39 . The bismuth‐quadruple therapy containing AMX plus furazolidone could achieve an eradication rate of more than 80% in both first‐line and rescue therapy, which was better than other traditional therapies 37,40 . Bismuth quadruple therapy with TET plus furazolidone could also achieve an eradication rate of 91.7% in ITT analysis for patients who failed from previous treatment 41 .…”

Management of Helicobacter pylori infection: Guidelines of the Italian Society of Gastroenterology (SIGE) and the Italian Society of Digestive Endoscopy (SIED)

“…Acid-suppressive drugs play a crucial role in eradication therapy by increasing the gastric bioavailability of antimicrobials and by increasing the number of dividing H. pylori, making the bacteria more susceptible to the action of antibiotics [80] . A meta-analysis has demonstrated that new-generation PPIs (i.e., esomeprazole or rabeprazole) are associated with significantly higher eradication rates than those obtained with first-generation PPIs (i.e., omeprazole, lansoprazole, or pantoprazole) [81] .…”