Treatment and Eradication of Helicobacter Pylori in a Safety-Net Health System

Background & Aims: Helicobacter pylori (HP) is the most common chronic bacterial infection worldwide, with a rising resistance rate, although the resistance patterns among minority and immigrant populations are not known. We aimed to determine the failure rate by treatment and race/ethnicity among adult patients with HP infection in a safety-net health system. Methods: We conducted a retrospective cohort study in a safety-net health system from January 2020 to December 2021 of patients diagnosed with HP based on serology, stool antigen, or stomach biopsies who were prescribed antibiotic therapy and had a test of eradication by either stool antigen or histology. The primary outcome was the HP treatment failure rate according to treatment type. Additional subgroup analyses examined the failure rate by age, race/ethnicity, and preferred language. Results: 167 patients carried a diagnosis of HP that was treated with a test of eradication. The median age was 47 (range 18-79); 60% were female, 52% Hispanic, and 25% Asian. 93% received a 14-day course, and 84% were prescribed clarithromycin-based triple therapy. The overall H. pylori treatment failure rate was 18%. The failure rate for quadruple therapy was nominally higher compared to triple therapy (29.2% vs. 16.3%, p=0.13). Younger patients (age ≤ 45) tended to experience treatment failure (24% vs. 13%, p=0.07). Asian (7.3%, p=0.01) and Cantonese-speaking patients (4.2%, p=0.02) had the lowest overall failure rates. Conclusions: In this study of diverse adult patients, triple therapy tended to be more effective than quadruple therapy. Triple therapy was particularly effective for Asian patients. These findings raise the possibility that triple therapy could still serve as a first-line regimen in certain populations.