Socioeconomic and demographic factors associated with failure in Helicobacter pylori eradication using the standard triple therapy.

AIM: To evaluate the influence of socioeconomic and demographic factors on the eradication rate of H. pylori, using standard triple therapy. BACKGROUND: the efficacy of the standard triple therapy (STT) for H. pylori eradication has decreased with the rise of antibiotic resistance. Other factors could influence the eradication failure, although available results are conflicting. METHODS: Retrospective study, including adults with H. pylori infection treated de novo with STT (proton pump inhibitor, amoxicillin and clarithromycin). Eradication success was assessed by 13C-urea breath test. Demographic and socioeconomics variables were evaluated and correlated with eradication treatment outcome. The confounder variables were controlled by logistic regression analysis. RESULTS: Out of 902 patients with H. pylori diagnosis, 693 met inclusion criteria (average age 53 years; females 55.2%). Non-significant differences were observed in relation to economics income between rural and urban areas (p=0.316). The eradication rate of H. pylori was 71.1%: male 78.9% vs female 65.9%, urban area 73.4% vs rural area 64.1%. With reference to age, income and nationality, the eradication rates were similar in all groups. According to logistic regression analysis, females had almost twice more likelihood of eradication failure in relation to males (OR 1.92; 95%CI: 1.38-2.72); and rural residents had OR 1.55 (95%CI: 1.03-2.33) for having eradication failure in contrast with urban population. CONCLUSION: Female gender and rural residence are factors associated with H. Pylori eradication failure with standard triple therapy.

The Validity of the Invasive Tests for Helicobacter Pylori Diagnosis is Unequally Affected by the Consumption of Antibiotics or Pump Inhibitors. Test Performance under Real-World Conditions.

BACKGROUND AND AIMS: Patients undergoing upper endoscopy have often used proton pump inhibitors (PPI) and/or antibiotics (ABx) recently. Both drugs have been associated with a poorer yield of the Helicobacter pylori (H. pylori) diagnostic tests. The aim was to assess the accuracy of the polymerase chain reaction test (qPCR), histological exam (HE) and ultra-fast urease test (UFUT) for H. pylori detection in patients that recently used PPI or ABx. METHODS: Prospective study recruiting 206 patients who underwent upper endoscopy and gastric biopsies. Demographics and use of PPI/ABx were obtained. Sensibility (Sn), specificity (Sp), predictive value (PV), likelihood ratio (LR) and PABAK concordance index, were calculated, considering as the gold standard the positivity of 2 out of 3 analyzed tests. A global analysis and another one based on the PPI/ABx intake were performed. RESULTS: 48.5% of patients used PPI and 12.8% ABx within the 2 and 4 weeks prior to endoscopy, respectively. The UFUT was positive in 13.1% of patients, HE in 34% and qPCR in 35.9%. UFUT achieved lower Sn (37%) than HE (98%) and qPCR (98%) (p<0.001) overall. ABx were associated with lower Sn in HE (p=0.04) and lower Sp in qPCR (p=0.03). PPI did not associate with a significant drop in Sn and Sp. The concordance between HE and qPCR was 0.83 (95%CI: 0.73-0.89). CONCLUSIONS: Under real world conditions, the accuracy and concordance of HE and qPCR to diagnose H. pylori were excellent, but UFUT achieved unsatisfactory outcomes. The intake of ABx was associated with the worse performance, fundamentally for HE. The PPI did not reduce the tests' yield significantly.