Andrew Mertz, MD1, Manish Singla, MD2, Kevin Pak, MD1, Zachary C. Junga, MD3; 1Walter Reed National Military Medical Center, North Bethesda, MD; 2Walter Reed National Military Medical Center, Washington, DC; 3Walter Reed National Military Medical Center, Bethesda, MD
Introduction: H. pylori infection (HPI) is common and is implicated in peptic ulcer disease, gastric cancer, gastric lymphoma, and functional dyspepsia. Treatment and cure leads to improved outcomes for these diseases. There is a dearth of United States data on treatment efficacy of antibiotic regimens in the last 20 years. Methods: This was a retrospective descriptive study of all TRICARE adult beneficiaries with HPI that were diagnosed, treated and tested for eradication at a military treatment facility between October 2015 and September 2018. Diagnoses were made via stool antigen testing (SAT), urea breath test (UBT), and IgG serologies (ST); only patients with a positive test, treatment, and eradication testing were included. This study was approved by the IRB at Walter Reed National Military Medical Center. Results: 20,548 unique H. pylori diagnostic tests were performed during the study period; 7215 SATs, 362 UBTs, and 12,971 STs. 1592 non-active duty and 374 active-duty patients were diagnosed, treated, and had eradication testing. Diagnostic testing was either IgG (1023), UBT (90), or SAT (853). The eradication testing was either UBT (159) or SAT (1807). The two best treatment regimens in the combined population were tetracycline-based bismuth quadruple therapy and tinidazole-based clarithromycin triple therapy with eradication rates of 85% and 82%. Non-active duty patients were more likely to clear with treatment than active duty patients (75.5% vs 70.6%, p = 0.045). The most common treatment regimen was clarithromycin triple therapy. No treatment regimen achieved greater than 80% eradication rates in the active duty population. Discussion: This is the largest HPI treatment efficacy study with the widest geographical distribution in the USA in over 20 years. No treatment regimen achieved an eradication rate greater than 90%; only 2 regimens in any population achieved eradication rates greater than 80%. Lower clearance rates in active duty patients may be explained by diverse geographic exposures and more frequent use of antibiotics. Our study may underestimate the efficacy of these regimens; we only included patients who underwent eradication testing. The selection of treatment shows a clear preference for triple therapy; this may be due to frequent treatment of PHI in primary care settings. The rates of eradication suggest that all patients treated for H. pylori should undergo eradication testing.
Treatment regimen efficacy table.
Flow Chart of Study Design
Testing locations and number of H. Pylori diagnoses in each region.
Disclosures: Andrew Mertz indicated no relevant financial relationships. Manish Singla indicated no relevant financial relationships. Kevin Pak indicated no relevant financial relationships. Zachary Junga indicated no relevant financial relationships.