Although 84% of gastroenterology providers almost always ordered eradication testing for their patients following treatment for Helicobacter pylori (H pylori), just 29% of all providers surveyed offered such testing and 23% were not aware eradication testing was needed, according to a poster presentation from Digestive Disease Week 2022

Among all respondents, which included family and internal medicine providers as well as gastroenterologists, 55% were not aware of clarithromycin resistance to H pylori

H. pylori is among the most common infections worldwide and is a predominant risk factor for both peptic ulcer disease and noncardia gastric adenocarcinoma, the authors noted. “We aimed to identify provider practices in a large academic multi-center setting. A 12-question survey was distributed via listservs to gastroenterology attendings, fellows, and advanced practice providers, as well as family medicine and internal medicine attendings and trainees across six different practice sites.”

The survey queried providers about their choices for initial H. pylori therapy, awareness of clarithromycin resistance in the United States, eradication testing, timing of eradication testing after antibiotics, withdrawal of proton pump inhibitor (PPI) before testing, and barriers to eradication testing and treatment.

Of the 111 responses received, 57% were trainees. The majority of responders (51%) were internal medicine faculty and trainees.

Most providers (73%) said they chose quadruple therapy for initial treatment of H pylori, while 26% chose clarithromycin-based triple therapy. Of the latter group, 83% were unaware that the United States has a presumed of ≥15% rate of clarithromycin resistance; among all respondents, 55% were not aware of clarithromycin resistance.

In regard to the need for eradication, 23% of providers did not know eradication testing was required and 33% seldom (0-25%) or sometimes (26-50%) ordered testing. Among providers who were aware of the need for eradication testing, 81% held PPI for 2 weeks prior to testing and 75% waited for 4 weeks after completion of PPI therapy before eradication testing.

The authors noted, “The top 3 barriers identified for H. pylori treatment were patient adherence, insurance coverage, and not having an easy order set. The top 3 barriers identified for H. pylori eradication testing were difficulty with stool testing, no designated follow-up, and provider knowledge. These survey results indicate a significant opportunity to improve H. pylori provider education in order to increase H. pylori eradication rates.”

--Rebecca Mashaw

Neelam A, Hang TVP, Mbonu C, Brown J. Assessing H. pylori treatment and eradication practices at a multicenter academic institution. Presented at: Digestive Disease Week; May 22, 2022. San Diego, California.