S2133 Helicobacter pylori Treatment: Retrospective Analysis of Factors That Are Associated With Eradication Testing and Infection Persistence

Introduction: Helicobacter pylori (Hp) is the strongest known risk factor for gastric malignancy. Prevalence of Hp in the U.S. is decreasing but remains a significant cause of morbidity. The American College of Gastroenterology guidelines recommend both treatment and post-treatment eradication testing. This study aimed to examine factors associated with lack of eradication testing and infection persistence despite testing. Methods: We retrospectively analyzed a cohort of patients diagnosed with Hp without gastric intestinal metaplasia during endoscopies performed at our institution from 2015-2019. Electronic medical records, including pathology and endoscopy reports, clinical notes, and medication records were extracted into a REDCap database with tissue-based cagA virulence factor testing (previously identified in 56% of this cohort). We compared patients’ characteristics at different points within the treatment pathway to determine factors associated with lack of eradication testing and Hp persistence. Results: There were 331 patients in the final racially balanced cohort, with the mean age of 56 years at index endoscopy with Hp diagnosis. Of these, 305 patients (92%) received Hp treatment after diagnosis. One hundred fifty-eight (52%) of the 305 patients received eradication testing after treatment. Black patients were more likely to have been treated without eradication testing compared to White patients (57% vs 44%, P = 0.04). Of the 158 patients who underwent eradication testing, 132 (84%) successfully cleared the infection and 26 (17%) had evidence of persistent infection, which was associated with neither race nor with evidence of the cagA virulence factor. Of those with persistent infection, clarithromycin was less likely prescribed (39% vs 62%, P = 0.03) and metronidazole was more likely prescribed (65% vs 41%, P = 0.02). Conclusion: The eradication testing rate in this cohort with Hp at endoscopy was 52%, with racial differences in receipt of eradication testing but not in treatment outcomes after eradication testing. Further, patients with evidence of cagA+ Hp had equally high treatment success as those without this virulence factor. While metronidazole is now suggested first-line treatment, treatment failures still occur, highlighting the importance of eradication testing. Our results demonstrate the need for rigorous follow-up care after Hp diagnosis across all groups.