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Adherence to H. pylori Treatment Guidelines Remains Fairly Low

Until the 1980s, it was common wisdom that gastritis and peptic ulcer disease were caused by stress. All of that changed with the discovery of the role of Helicobacter pylori in those gastrointestinal conditions.

Yet, decades later, many physicians aren’t following guidelines on testing, treating, or confirming eradication of the bacteria.

That’s based on a study published in Preventive Medicine to determine how much U.S. physicians followed American College of Gastroenterology guidelines based on the H. pylori discovery — considered so groundbreaking, the researchers received the Nobel Prize in Physiology or Medicine in 2005.

Background information in the article notes that the infections are linked to significant morbidity, including gastric cancer.

Specifically, researchers from the Mel and Enid Zuckerman School of Public Health at the University of Arizona sought to determine whether the guidance was being followed on the care and management of patients with H. pylori infections. Included in the guidelines are when and how to test for the pathogen, as well as treatment advice.

The study team distributed online surveys in 2014 to practicing gastroenterology physicians, and received 582 responses. They determined that the H. pylori screening test used “almost always” was gastric biopsy obtained during endoscopy (59%), followed by the stool antigen test (20%).

In terms of treatment, standard triple therapy for 14 days was commonly prescribed by 53% of respondents. While the stool antigen test was most frequently chosen to confirm H. pylori eradication (51%), only 58% of physicians checked for eradication in patients who underwent treatment.

Most physicians followed the guidelines for testing patients they suspected of having H. pylori infection when the patients came to them with likely risk factors, such as a previously diagnosed peptic ulcer or dyspepsia, noted senior author Eyal Oren, PhD, MS.

"You shouldn't be testing everybody, but if there are reasons to believe that a test for H. pylori may come back positive, and it does come back positive, you should go on to treat," added lead author Traci Murakami, MD, previous gastroenterology fellow at UA who now is an assistant clinical professor of medicine at the University of Hawaii, Manoa.

The results indicate that a higher proportion of physicians — 84% — treat patients after a positive H. pylori test now than in the past, Oren pointed out.

The relatively low 58% of physicians who confirmed eradication of the bacterium is of concern, Murakami says, because treatment failure could indicate growing drug resistance.

Another worry, according to study authors, is that 6% of the physicians said they didn’t question patients about antibiotics they previously used.

Researchers concluded that the "adaptation of a 'test, treat, and retest strategy' to confirm eradication after treatment is an area that could be improved."

"If we could identify it early and identify it in more people, we might be able to reduce the risk of people developing stomach cancer in the future," Murakami added.