S1852 A Retrospective Analysis of Helicobacter Pylori Treatment and Follow-Up in a Tertiary Hospital in West Virginia

Introduction: Helicobacter pylori infection (H. pylori) affects approximately 36% of the United States population and colonizes 50% of the world’s population for life unless eradicated with antibiotics. Colonization with this organism is the main risk factor for peptic ulcer, gastric lymphoid lymphoma, and gastric adenocarcinoma. Our study aims to ascertain the follow-up of H. pylori-positive patients in a tertiary hospital and treatment eradication. Methods: We studied 153 patients who tested positive for H. pylori infection in Cabell Huntington Hospital between July 2021 and March 2023. Patients were classified into treated and untreated groups. The 2 groups were compared based on their demographics, BMI, EGD findings, and departments involved. Student t-test was used to compare continuous variables and the chi test for the categorical variables. A subgroup analysis of the treated group was done based on the type of therapy received and the follow-up fecal antigen test for H. pylori eradication. P-value < 0.05 was considered statistically significant. Results: We found that 72.5% (n = 111) of patients that tested positive for H. pylori, were treated. Amongst the treated, 95% had EGD procedures done by Gastroenterology (GI) service. On the untreated arm (n = 42), EGD was done by surgery service in 45% as against 26% by GI service (P value = < 0.001). Those treated were more likely to be prescribed quadruple therapy than triple therapy (P-value = 0.001). We found that positive biopsies after sleeve gastrectomy were unlikely to be treated (P-value = < 0.001). Hiatal hernia was present in 86% of treated versus 20% of untreated (P-value = 0.001). Only 32% of the treated patients had repeat H. pylori testing (fecal antigen) done to check for eradication, of which 27% tested positive (P-value = 0.001), Figure 1. Though not significant, the severity of gastritis was higher in treated versus untreated (P-value = 0.071). Conclusion: Long-term carriage of H. pylori increases the risk of site-specific diseases. Our study showed that 27.5% of H. pylori-positive patients were untreated. In general, even though the GI department had the highest number of patients treated, all departments have room for improvement regarding patient follow-up. We advocate for further education regarding H. pylori treatment and confirmatory eradication tests (fecal antigen) to improve patient care overall (Table 1).Figure 1.: Sub-analysis of the treated H. pylori-positive group. Table 1. - Baseline characteristics of H. pylori positive biopsy (treated versus untreated) Positive H. pylori biopsy (untreated) Positive H. pylori (Treated) P Value Number of patients 42 111 Age (mean (SD)) 52.67 (16.99) 52.68 (16.42) 0.995 Female (%) 24 (57.1) 75 (67.6) 0.310 Race = White (%) 36 (85.7) 102 (91.9) 0.400 Ethnicity = Non-Hispanic (%) 40 (95.2) 111 (100.0) 0.129 BMI (mean (SD)) 34.37 (11.25) 31.42 (8.94) 0.093 History of Sleeve gastrectomy (%) 12 (28.6) 3 (2.7) < 0.001 Service who took care of the patients (%) < 0.001 Gastroenterology 11 (26.2) 106 (95.5) Surgery 19 (45.2) 4 (3.6) Indications for EGD (%) < 0.001 GERD or dysphagia 12 (28.6) 40 (36.0) Beriatric 10 (23.8) 0 (0.0) Anemia, GI bleed, Liver cirrhosis 8 (19.0) 21 (18.9) Other GI symptoms 12 (28.6) 50 (45.0) H. pylori diagnosis method (%) 0.083 immunohistochemistry staining 35 (83.3) 75 (67.6) Hematoxylin and Eosin staining 7 (16.7) 36 (32.4) Repeat H. pylori testing (Fecal antigen + EGD) (%) 5 (11.9) 35 (31.5) 0.024 Gastritis severity (%) 0.071 Mild 11 (26.8) 37 (33.3) Moderate 23 (56.1) 68 (61.3) Severe 7 (17.1) 6 (5.4) Peptic ulcer (%) 6 (14.3) 14 (12.6) 0.996 Hiatal Hernia 20 (47.6) 86 (77.5) 0.001