Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2020; 26(32): 4846-4856
Published online Aug 28, 2020. doi: 10.3748/wjg.v26.i32.4846
Current status of Helicobacter pylori eradication and risk factors for eradication failure
Tian-Lian Yan, Jian-Guo Gao, Jing-Hua Wang, Dan Chen, Chao Lu, Cheng-Fu Xu
Tian-Lian Yan, Jian-Guo Gao, Jing-Hua Wang, Dan Chen, Chao Lu, Cheng-Fu Xu, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Author contributions: Yan TL and Gao JG contributed equally to this work; Xu CF, Yan TL, and Lu C designed the research; Yan TL, Gao JG, and Chen D performed the research; Wang JH analyzed the data; Yan TL and Xu CF drafted and revised the manuscript. All authors approved the final draft of this manuscript for submission.
Supported by the National Natural Science Foundation of China, No. 81600447.
Institutional review board statement: This study was reviewed and approved by the Clinical Research Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine.
Informed consent statement: Because of the retrospective and anonymous nature of this study, the need for informed consent was exempted by the institutional review board.
Conflict-of-interest statement: All of the authors declare that they have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Cheng-Fu Xu, MD, Doctor, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China.
Received: April 24, 2020
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
Processing time: 126 Days and 5.5 Hours
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.