A Test And Treat Strategy For H.pylori Infection: Is It Failing As A Result Of Inappropriate Follow Up?
C Costigan, F O’Hara, J O’Connell, D McNamara.
Dept. of Gastroenterology, Tallaght University Hospital, Dublin.
Gastric cancer rates have fallen hugely worldwide, largely attributed to eradication of H.pylori. The decrease has slowed drastically in Europe, possibly related to increased antibiotic resistance and associated lower eradication rates. Assessment of treatment success, as recommended, is therefore of paramount importance.
To explore compliance with post eradication H.pylori assessment in a tertiary referral centre.
A retrospective review of Urea Breath Tests (UBTs) over a 12 month period July 2021-2022 was performed from a database and cross referenced with patient electronic records. Demographics, indication (diagnostic or post eradication), referral source, result and subsequent OGD +/- H. pylori testing was documented.
In all 1,029 UBTs were identified, mean age= 45 years, 604(59%) were female, positivity rate=22% (n=223). Of positive tests, 141(63%) were diagnostic and 83(37%) were post-eradication. Of positive tests 40%(n=89) had post-eradication UBTs performed or booked, at the time of analysis. Patients were not statistically less likely to be referred for a post eradication UBT from General (43/105, 41%) or Hospital practice (46/118, 39%), p=0.766. No patients had undergone an OGD and H.pylori testing as an alternative means of assessing eradication success.
H.pylori infection remains common affecting 1:5 of our population. While external testing cannot be excluded and appropriate therapy is assumed, these results are disappointing. The majority treated for infection with this type-1 carcinogen do not have appropriate follow up. We propose introducing treatment recommendations with automatic scheduling of repeat tests for all positive reports.