E0681 - Helicobacter pylori Eradication Testing: Is Ordering or Completion the Issue? A Retrospective Review of a Single Health System

William S. Reiche, DO¹, Bryce Schutte, DO¹, Omar Alaber, MD¹, Suhail Sidhu, BS², Ryan Walters, PhD², Erin Jenkins, MD^1
1CHI Creighton University Medical Center, Omaha, NE; ²Creighton University School of Medicine, Omaha, NE

Introduction: Helicobacter pylori (H. pylori) is one of the leading causes of peptic ulcer disease and gastric cancer worldwide. Treatment is typically a combination of antibiotics with a proton-pump inhibitor (PPI). Testing for eradication, recommended by the most recent ACG practice guidelines, is paramount as H. pylori resistance rates continue to rise and salvage therapy can be offered if initial treatment was unsuccessful. Eradication testing may include urea breath testing, stool antigen testing, or biopsy and should be performed at least 4 weeks after completion of H. pylori treatment and two weeks after PPI-therapy is held. In this study, we determined if eradication testing ordering practices vary based on patient age, patient primary payer, patient primary language spoken, and gastroenterology (GI) vs. non-GI ordering specialty. We also compared eradication testing ordering and completion rates.

Methods: We performed a retrospective chart review of Catholic Health Initiatives health system between January 2019 and January 2021 to obtain data regarding H. pylori eradication testing ordering practices. Differences were evaluated using the chi-square test, Fisher's exact test, and lognormal regression models.

Results: Of 433 patients (41.1% male; 58.9% female), eradication testing was not ordered in 218 patients (47.8%). In the 238 (52.2%) patients who had eradication testing ordered, H. pylori stool antigen testing was ordered 73.5% of the time. GI ordered eradication testing 67.6% (58.3-75.6) of the time compared to 47.3% (42.0-52.5) by non-GI ordering specialty (p < 0.001), Table 1. When testing was ordered it was completed 89.5% of the time. There was no significant difference in eradication ordering practice based on sex, primary payer, or language. Eradication testing was most likely to be ordered in patients aged 35-60 (p = 0.046), Figure 1.

Discussion: In a large health system consisting of academic and non-academic hospitals and clinics eradication testing was performed only half the time and was more frequently ordered in middle-aged patients. The low number of ordered eradication tests may reflect providers’ unfamiliarity with clinical guidelines and may be contributed by additional inherent age bias. In our cohort which included 40% non-English speakers, language was not a barrier to test completion. Efforts should focus on education about testing for treatment success particularly in primary care and non-GI specialties.




Disclosures:


William S. Reiche, DO¹, Bryce Schutte, DO¹, Omar Alaber, MD¹, Suhail Sidhu, BS², Ryan Walters, PhD², Erin Jenkins, MD¹. E0681 - Helicobacter pylori Eradication Testing: Is Ordering or Completion the Issue? A Retrospective Review of a Single Health System, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.