Eradication Testing Recommended for Patients Treated for Helicobacter pylori Infection

Improving treatment in H pylori infection could lead to better outcomes in peptic ulcer disease, gastric cancer, gastric lymphoma, and functional dyspepsia.

Tetracycline-based bismuth quadruple therapy and tinidazole-based clarithromycin triple therapy were found to be the most effective treatments for patients with Helicobacter pylori infection at a military treatment facility, according to research presented at the Liver Meeting Digital Experience, hosted by the American Association for the Study of Liver Diseases.

Investigators conducted a retrospective descriptive study of all TRICARE adult beneficiaries with H pylori infection who were diagnosed, treated, and tested for eradication at a military treatment facility between October 2015 and September 2018. The diagnoses were made with use of stool antigen testing, urea breath test, and IgG serologies.

A total of 20,548 unique H pylori diagnostic tests were performed (7215 stool antigen tests, 362 urea breath tests, and 12,971 IgG serologies). Within this group, 1592 nonactive-duty and 374 active-duty patients were diagnosed, treated, and underwent eradication testing. Diagnostic testing was done with IgG (1023), urea breath test (90), or stool antigen testing (853). Eradication testing was done with urea breath test (159) or stool antigen testing (1807).

Tetracycline-based bismuth quadruple therapy and tinidazole-based clarithromycin triple therapy were found to be the best treatment regimens in the combined population, with eradication rates of 85% and 82%, respectively. Nonactive-duty patients were more likely to clear infection with treatment compared with active-duty patients (75.5% vs 70.6%, respectively; P =.045). Clarithromycin triple therapy was the most common treatment regimen. No treatment had an eradication rate greater than 80% in the active-duty population.

“Lower clearance rates in active-duty patients may be explained by diverse geographic exposures and more frequent use of antibiotics,” the researchers commented.

“Our study may underestimate the efficacy of these regimens; we only included patients who underwent eradication testing. The selection of treatment shows a clear preference for triple therapy. This may be due to frequent treatment of H. pylori infection in primary care settings. The rates of eradication suggest that all patients treated for H. pylori should undergo eradication testing.”


Mertz A, Singla M, Pak K, Junga ZC. Helicobacter pylori treatment and eradication rates in Department of Defense patients from 2016-2018. Poster presented at: The Liver Meeting Digital Experience; November 13-16, 2020. P67 (S1319).