Mistakes in the diagnosis and treatment of Helicobacter pylori infection in daily clinical practice

Abstract

Background: An adequate diagnostic and therapeutic approach to Helicobacter pylori (H. pylori) infection is the cornerstone to avoid overdiagnosis, overuse of health resources, and increase in antibiotic resistances. The aim of the study was to evaluate the most common errors in clinical practice and the associated risk factors. Materials and Methods:This is a retrospective observational study including patients with H. pylori infection and no previous treatment belonging to two defined areas of the National Health System in Spain; some of them were enrolled in the European Registry on H. pylori management (Hp-EuReg). Patients were attended by gastroenterologists between 2010 and 2019. According to current guidelines, we evaluated indications for H. pylori investigation, appropriateness of diagnostic test used in dyspeptic patients and discontinuation of surveillance after treatment.Results: A total of 1730 patients were included, receiving 2260 eradication regimens.H. pylori infection was investigated in 1.7% cases in absence of a formal indication.Oral endoscopy was incorrectly used in 56% of patients with dyspepsia under 55 years without alarm signs, and urea breath test (UBT) was incorrectly used in 22.4% of patients with dyspepsia ≥55 years or red flags. Levofloxacin containing regimens were used as first-line therapy in 7.5% of non-allergic to penicillin patients. After first-line failure, clarithromycin was repeated in 2.6% of the patients who received second-line therapy. Confirmatory test of H. pylori status was absent in 2.5% cases. Men, patients under 55 years, and patients diagnosed by UBT had a higher risk of not undergoing a confirmatory test. Conclusions: Investigation of H. pylori infection by gastroenterologists is rare in absence of a formal indication; however, endoscopy is commonly used for dyspeptic patients <55 years without red flags and non-invasive tests are still used for dyspeptic patients ≥55 years or presenting alarm signs. Men, patients under 55 years, and patients diagnosed by UBT have an increased risk of being lost to follow-up after eradication treatment.

Real‐world practice of Helicobacter pylori management: A survey among physicians in Southeast Asia

“…In a recent study evaluating prescriptions for H. pylori eradication in Spain, a high-CLA country where PBMT is currently recommended as the first-line regimen, there was an overuse of levofloxacin as the first-line regimen (7.5%) and clarithromycin as the second-line regimen (2.6%). 5 Another study conducted in China reported that the status of prescribing eradication regimens containing antibiotics with high resistance rates was even more alarming. 6 Regarding first-line treatment, 17.5% of physicians used at least one antibiotic with a high resistance rate in triple therapy, and 11.2% used two antibiotics with high resistance rates in quadruple therapy.…”

“…In a recent study evaluating prescriptions for H . pylori eradication in Spain, a high‐CLA country where PBMT is currently recommended as the first‐line regimen, there was an overuse of levofloxacin as the first‐line regimen (7.5%) and clarithromycin as the second‐line regimen (2.6%) 5 . Another study conducted in China reported that the status of prescribing eradication regimens containing antibiotics with high resistance rates was even more alarming 6 .…”

“…4 In addition to poor patient compliance, prescribing inappropriate regimens by physicians could be another important factor contributing to treatment failure. 5,6 Ideally, all eradication regimens should be based on antibiotic susceptibility testing (AST). However, AST is still not widely available, and empiric therapies are still popular in many regions worldwide, particularly in countries with limited resources.…”

“…In addition to poor patient compliance, prescribing inappropriate regimens by physicians could be another important factor contributing to treatment failure 5,6 . Ideally, all eradication regimens should be based on antibiotic susceptibility testing (AST).…”

Celiac Disease-Related Enamel Defects: A Systematic Review

“…Studies propose that CD may interfere with the normal mineralization of dental enamel, resulting in structural abnormalities [ 16 ]. Enamel defects, such as pitting, grooving, and discoloration, have been reported in individuals with CD, providing potential oral markers for the condition [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ].…”