Temporal Trends in Helicobacter pylori Eradication Success in a Test-and-Treat Population

Boltin, Doron; Schmilovitz‐Weiss, Hemda; Gingold‐Belfer, Rachel; Leibovitzh, Haim; Snir, Yifat; Perets, Tsachi Tsadok; Dickman, Ram; Levi, Zohar; Niv, Yaron

doi:10.1159/000488448

Cited by 4 publications

(1 citation statement)

References 24 publications

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“…Most participants in our study reportedly prescribed triple therapy. This is despite the increase in clarithromycin resistance in H. pylori strains in Israel [37] and the low success rates in H. pylori eradication [38].…”

Section: Discussionmentioning

confidence: 99%

Physicians’ adherence to management guidelines for H. pylori infection and gastroesophageal reflux disease: a cross-sectional study

Na’amnih

Ben‐Tov

Bdair-Amsha

et al. 2020

Isr J Health Policy Res

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Background: Primary care physicians (PCPs) play a pivotal role in the management of illnesses of the digestive tract. The study aim was to assess the adherence of PCPs to the guidelines on the management of Helicobacter pylori (H. pylori) infection and gastroesophageal reflux disease (GERD) in adults. Methods: We conducted a cross-sectional study during March-July 2017 using the survey platform of Maccabi Healthcare Services in Israel. The study questionnaire assessed adherence to the Maastricht/Florence guidelines on H. pylori infection and the American College of Gastroenterology guidelines on the management of GERD. We sent the study questionnaires to a random sample of 610 PCPs via electronic mails. We contacted those who did not respond by telephone; eventually 180 physicians completed the survey. Results: Ninety (50%) and 60 (36%) of the responders reported using professional guidelines for the diagnosis and management of H. pylori infection and GERD, respectively. Of the 180 participants, 153 (85%) reported referring patients with suspected peptic ulcer disease to H. pylori testing, 109 (61%) reported referring patients with unexplained iron deficiency anemia and 83 (46%) refer relatives of gastric cancer patients. In caring for young patients who have dyspepsia without alarm symptoms, 127 (74%) reported referral to a urea breath test for the diagnosis of H. pylori infection, and 136 (81%) referral to a specialist in gastroenterology if alarm symptoms present. Triple therapy with proton pump inhibitors/clarithromycin/amoxicillin or metronidazole was reported as first-line therapy by 141 (83%) participants. For GERD, 94-98% of the participants followed the appropriate recommendations. Conclusions: We identified gaps between the practices of PCPs and the guidelines on H. pylori infection management, while guidelines on GERD management are well adopted. Simplification of the guidelines and exploring barriers towards their implementation by PCPs is warranted.

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Section: Discussionmentioning

confidence: 99%

Physicians’ adherence to management guidelines for H. pylori infection and gastroesophageal reflux disease: a cross-sectional study

Na’amnih

Ben‐Tov

Bdair-Amsha

et al. 2020

Isr J Health Policy Res

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Use of proton pump inhibitors is associated with lower rates of first‐time ischemic stroke in community‐dwelling elderly

Schmilovitz‐Weiss

Gingold‐Belfer

Peleg

et al. 2020

Brit J Clinical Pharma

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Aim Data on cardiovascular outcomes in elderly using proton pump inhibitors (PPI) are scant. We aimed to test the association between PPI use and the occurrence of first‐time ischemic stroke (FTIS) among elderly. Methods The electronic database of a centrally located district branch of a large health maintenance organization in Israel was retrospectively screened (2002–2016) for community‐dwelling individuals (≥65–95 years) for demographics and co‐morbidities. Follow‐up was until FTIS, death or end of study. Findings were analyzed by PPI use and occurrence of FTIS. Results 29,639 subjects (without history of stroke and use of antiplatelet aggregation drugs) mean age of 82.2 ± 5.5 years (range: 65–95 years, 38% male) were analyzed: 8,600 (29%) used PPIs. Mean follow up was 10.58 years (SD ± 5.44). Similar total and annual occurrence rates of FTIS were depicted in PPI users and non‐users (20.9% vs. 21% and 2% vs. 2.1%, respectively). On a Cox regression analysis, upon adjustment for age, gender and cardiovascular disease related risk factors, PPI use was significantly associated with lower rates of FTIS (HR 0.73, 95% C.I. 0.69–0.77, p < 0.001). The risk for FTIS was significantly lower in subjects using PPI at any dose and for any time period compared to non‐users (HR 0.9, 95% C.I. 0.85–0.96 for 7–48 yearly prescriptions and HR 0.51, 95% C.I. 0.46–0.55 for ≥49 yearly prescriptions). Conclusions PPI use was associated with lower rates of FTIS in community‐dwelling elders. Prospective large‐scale studies are needed to fully elucidate the effect of PPI in this aging population.

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High‐dose amoxicillin‐proton pump inhibitor dual therapy as first‐line treatment for Helicobacter pylori infection in Northwest China: A prospective, randomised controlled trial

Yun

Wang

et al. 2022

Brit J Clinical Pharma

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Aims We aimed to assess the eradication efficacy and factors that influencing it of high‐dose dual therapy (HDDT) in Gansu region, Northwest China. Methods A total of 216 treatment‐naive patients with Helicobacter pylori infection were randomly assigned to two groups for the 14‐day eradication treatment: the HDDT group (amoxicillin 750 mg q.i.d. and esomeprazole 40 mg t.i.d.) and the amoxicillin and clarithromycin‐containing bismuth quadruple therapy group (ACBQT: esomeprazole 20 mg, bismuth potassium citrate 2 g, amoxicillin 1 g, and clarithromycin 500 mg; b.i.d.). The eradication rates, adverse effects and patient compliance of these two groups were compared. Eradication efficacy was determined by 13C urea breath test (13C UBT) 4–8 weeks after finishing treatment. Antibiotic resistance was determined by the Epsilometer testing (E‐test) method. Results The eradication rates for the HDDT and ACBQT groups were 71.0% and 74.7% (P = .552) by per‐protocol analysis, and 65.7% and 68.5% (P = .664) by intention‐to‐treat analysis. The overall adverse event rates in the HDDT and ACBQT groups were 2.0% and 43.4% (P < .001), respectively. The resistance rates to amoxicillin, clarithromycin, tetracycline, levofloxacin and metronidazole were 15.2%, 42.0%, 5.4%, 35.7% and 83.0%, respectively. Amoxicillin resistance and delta over baseline (DOB) of 13C UBT ≥ 20 before treatment significantly reduced the eradication rate in 112 participants with H. pylori cultured. Conclusion The HDDT as first‐line treatment for H. pylori was unsatisfactory in Gansu. Amoxicillin resistance and DOB of 13C UBT ≥ 20 before treatment were significantly correlated with H. pylori eradication failure.

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Temporal Trends in Helicobacter pylori Eradication Success in a Test-and-Treat Population

Cited by 4 publications

References 24 publications

Physicians’ adherence to management guidelines for H. pylori infection and gastroesophageal reflux disease: a cross-sectional study

Physicians’ adherence to management guidelines for H. pylori infection and gastroesophageal reflux disease: a cross-sectional study

Use of proton pump inhibitors is associated with lower rates of first‐time ischemic stroke in community‐dwelling elderly

High‐dose amoxicillin‐proton pump inhibitor dual therapy as first‐line treatment for Helicobacter pylori infection in Northwest China: A prospective, randomised controlled trial

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