An online survey developed by University of Arizona researchers showed that few gastroenterologists in the U.S. consistently adhere to the 2007 ACG guideline recommendations for the diagnosis and management of patients with Helicobacter pylori infection.
Just over half of the 582 physicians who completed the survey in 2014 said they checked for complete H. pylori eradication in patients who underwent treatment.
However, most physicians adhered to the guidelines for testing patients with suspected H. pylori infection who had risk factors like peptic ulcer or dyspepsia, and almost always used gastric biopsy on endoscopy (59%) or stool antigen tests (20%) for screening.
“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,” Traci T. Murakami, MD, assistant clinical professor of medicine at the University of Hawaii, Manoa, formerly of the University of Arizona Medical Center and the Mel and Enid Zuckerman College of Public Health, said in a press release.
Additionally, the results showed 84% of gastroenterologists would treat patients who test positive, which is a higher proportion than in previous years. Most respondents (53%) prescribed standard triple therapy for 14 days for H. pylori eradication.
However, just 58% said they routinely confirm eradication after treatment, which is concerning as incomplete eradication could indicate drug resistance, Murakami noted in the press release.
“Only half of gastroenterology physicians check for eradication,” she said. “I think that’s key because knowing if a patient eradicated the H. pylori versus whether they still have the infection may indicate that they may have a more resistant type of H. pylori that didn’t respond to the initial antibiotic and would require different antibiotics to eradicate it.”
Of those who reported they would confirm eradication, 51% used the stool antigen test.
The survey also showed that 6% of respondents did not ask their patients about previous antibiotic use, which could indicate the potential for drug resistance. Respondents also indicated they were not routinely testing for resistance.
The researchers concluded that “adaptation of a ‘test, treat and retest strategy’ to confirm eradication after treatment is an area that could be improved,” and noted that the new 2017 ACG guideline on H. pylori management “provides more explicit guidance for gastroenterologists by expanding the indications for testing of H. pylori, incorporating previous antibiotic exposure in the decision making process of choosing therapy, and recommending testing to provide eradication whenever H. pylori is identified and treated.”
“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 said in the press release. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.