Helicobacter pylori Treatment Regimen Selection and Eradication Rates Across Department of Defense Patients for Fiscal Years 2016-2018

Zachary C Junga; Andrew Mertz; Kevin Pak; Manish Singla

doi:10.1093/milmed/usac428

Helicobacter pylori Treatment Regimen Selection and Eradication Rates Across Department of Defense Patients for Fiscal Years 2016-2018

Mil Med. 2023 Jan 12:usac428. doi: 10.1093/milmed/usac428. Online ahead of print.

Authors

Zachary C Junga^{1

2

3}, Andrew Mertz^{1

2}, Kevin Pak^{2

4}, Manish Singla^{1

2}

Affiliations

¹ Division of Gastroenterology, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
² Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA.
³ Gastroenterology Service, Landstuhl Regional Medical Center, Landstuhl 66849, Germany.
⁴ Department of Medicine, Division of Gastroenterology, Naval Medical Center San Diego, San Diego, CA 92134, USA.

PMID: 36632809
DOI: 10.1093/milmed/usac428

Abstract

Introduction: The objective of this study was to measure the number of treatment successes and failures of various Helicobacter pylori treatment regimens among DoD beneficiaries.

Materials and methods: This was a retrospective cross-sectional study of all adult DoD beneficiaries with H. pylori diagnosis, treatment, and eradication testing from October 2015 to September 2018. All stool antigen testing, urea breath test, and immunoglobulin G serologies were identified. Patients were excluded if they did not have a positive test, did not have treatment, or did not have eradication testing.

Results: In total, 20,548 H. pylori diagnostic tests were performed over the study period. A total of 1,592 non-active duty and 374 active duty patients were diagnosed with H. pylori, were treated, and had eradication testing. The best performing regimens were tetracycline-based bismuth quadruple therapy and tinidazole-based clarithromycin triple therapy with eradication rates of 85% and 82%, respectively. Clarithromycin triple therapy was the most prescribed (63.9% of all regimens included in analysis). Of the 1,592 non-active duty and 374 active duty patients, 75.5% (1,202) and 70.6% (264) cleared the infection with treatment, respectively (P = 0.0449). Although trends were identified in differences in geographic eradication rates, none of these achieved the threshold of significance.

Conclusions: This is the largest and most geographically widespread H. pylori treatment efficacy study in the USA over 20 years. None of the treatment regimens (when used in over five patients) achieved an eradication rate greater than 90%, but tetracycline-based bismuth quadruple therapy performed best among all regimens and populations. Eradication rates were lower in the active duty populations, with no treatment regimen achieving an eradication rate greater than 80%.

Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.