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HOW WELL IS HELICOBACTER PYLORI TREATED? AN INTERIM ANALYSIS
K Yogeswaran1, G Chen2, L Cohen2, M Cooper2, E Yong2, E Hsieh2, C Rowsell2, F Saibil2, J Tinmouth2
1University of Toronto; 2Sunnybrook Health Sciences Centre, Toronto, Ontario
Aims: H. pylori is a WHO Class 1 carcinogen implicated in peptic ulcer disease, MALT lymphoma, and gastric adenocarcinoma. Treatment is warranted,especially in these disease states. However, data is lacking regarding treatment rates in a "real world" setting. Our aim was to characterize the treatment of patients with H. pylori and identify predictors of sub-optimal treatment and follow-up at Sunnybrook Health Sciences Centre(SHSC)in Toronto. We present our interim results.
Methods: SHSC patients diagnosed with H. pylori on a gastric biopsy in the year 2007 were identified. Demographic, clinical, endoscopic and pathological data pertinent to the H. pylori diagnosis were collected via chart review. We calculated the proportion of total patients who received eradication therapy, and where indicated, confirmation of eradication and repeat gastroscopy. We also determined the proportion of patients who received "complete treatment," defined as receiving eradication therapy and confirmation of eradication where indicated. These analyses were repeated by inpatient/outpatient status, endoscopic and pathological diagnoses, and by physician follow-up. Chi-square testing was used (p-values <0.05 were statistically significant).
Results: Our sample consisted of 111 patients. Median age was 60 years, 42% were female and 25% were inpatients. The most common indications for endoscopy were dyspepsia (21%), anemia (18%), and GI bleeding (15%). In the entire sample, 55% received eradication therapy and, where indicated, 45% had confirmation of eradication and 50% had repeat gastroscopy. 53% met our definition of complete treatment. Outpatients, patients with formal follow-up, and those with follow-up with a gastroenterologist were more likely to receive eradication therapy and complete treatment (Table 1). There were no significant differences in treatment rates by endoscopic or pathologic diagnoses.
Conclusions: Our interim analysis demonstrates that outpatients and patients with follow-up, especially with a gastroenterologist, were more likely to receive complete treatment for H. pylori. Further exploration of potentially modifiable processes of care contributing to sub-optimal treatment of persons diagnosed with H. pylori is warranted.
Table 1
Eradication therapy and complete treatment rates in Helicobacter pylori patient subgroups