Emory University School of Medicine Atlanta, Georgia
Introduction: Helicobacter pylori (H. pylori) is a prevalent infection in the United States, with a lifetime prevalence of about 33%. H. pylori is a strong risk factor for dyspepsia, peptic ulcer disease, and gastric adenocarcinoma; ensuring prompt treatment and confirmed eradication of this infection is imperative. Unfortunately, H. pylori disproportionately affects people of lower socioeconomic status. Prior studies have shown that race, gender, income, and rural habitation correlate with higher risk of eradication failure. This study aimed to assess socioeconomic, demographic, and clinical barriers to care for patients with H. pylori in a large safety-net hospital.
Methods: A retrospective chart review was conducted on 694 patients who were at least 18 years old with biopsy proven H. pylori infection between November 2015 and May 2021. Demographic data, endoscopy indications and findings, appointment follow up, treatment regimens and durations, and characteristics of eradication testing were collected. The data were analyzed using a combination of the Pearson chi-squared test, T-test, and logistic regressions to assess the influence of various variables on: (1) ordering of eradication testing, (2) completion of eradication testing (if ordered), and (3) achievement of eradication.
Results: Overall, eradication testing was ordered for 50.5% of patients. Of patients who had eradication testing ordered, 66.8% completed testing. Of patients who completed testing, 85.6% achieved successful eradication. Gender, endoscopy setting, patient follow-up, and treatment type were statistically significant factors influencing both if eradication testing was ordered and if completed by the patient (all P < 0.05). Preferred language, Gini index, days from endoscopy to follow-up, and scheduled follow-up by a provider were significantly associated with completion of eradication testing by the patient (all P < 0.05). There were no statistically significant factors impacting successful eradication.
Discussion: Ideally, eradication testing should be ordered and completed for every patient treated for H. pylori. Given that testing was ordered for just above half of patients, there is significant room for improvement in the process of ordering eradication testing for patients in vulnerable populations. The results of this study make imperative the need to address H. pylori treatment disparities, particularly, in safety-net healthcare systems in order to improve clinical outcomes.
