Published online Aug 28, 2020. doi: 10.3748/wjg.v26.i32.4846
Peer-review started: April 24, 2020
First decision: June 13, 2020
Revised: July 18, 2020
Accepted: July 30, 2020
Article in press: July 30, 2020
Published online: August 28, 2020
Helicobacter pylori (H. pylori) is a widespread bacterium that affects approximately 50% of the world’s population and induces numerous gastrointestinal and extragastric diseases. Currently, H. pylori infection is considered the most important (yet controllable) risk factor for gastric cancer. To date, there are limited data in clinical practice regarding eradication rate and factors related to therapy failure.
In recent years, H. pylori eradication therapies are facing decreasing eradication rates. However, risk factors related to therapy failure are still uncertain. In addition, there is a lack of recent eradication rate from China. Study in this aspect will certainly be helpful to improve the effectiveness of anti-H. pylori therapy in the future.
This study aimed to evaluate the H. pylori eradication status in the local population of Eastern China and to explore factors related to eradication failure.
Medical records for patients with H. pylori infection who underwent standard 14-d quadruple therapy and received urea breath test after treatment were retrospectively reviewed. Eradication rates were calculated and compared between regimens and subgroups. Multivariate analysis was performed to identify predictors of eradication failure.
Of 2610 patients enrolled, eradication was successful in 1999 (76.6%) patients. Amoxicillin-containing quadruple regimens showed a higher eradication rate than other quadruple therapy regimens (83.0% vs 69.0%, P < 0.001). The quadruple therapy containing amoxicillin plus clarithromycin achieved the highest eradication rate (83.5%). Primary therapy had a higher eradication rate than rescue therapy (78.3% vs 66.5%, P < 0.001). In rescue therapy, amoxicillin- and furazolidone-containing regimens achieved the highest eradication rate (80.8%). Esomeprazole-containing regimens showed a higher eradication rate than those containing other proton pump inhibitors (81.8% vs 74.9%, P = 0.001). Multivariate regression analysis found that older age, prior therapy, and use of omeprazole or pantoprazole were associated with an increased risk of eradication failure.
This study confirmed that the total eradication rate is 76.6% in eastern China. Amoxicillin-containing regimens are superior to other regimens. Age, prior therapy, and use of omeprazole or pantoprazole are independent risk factors for eradication failure.
This study can improve the choice of antibiotics and proton pump inhibitors and indicates that in clinical practice, attention should be paid to elderly patients and rescue therapy. Further prospective research focusing on optimizing the treatment strategies considering these factors is required.