Background: Helicobacter pylori (HP) infection is one of the most prevalent chronic bacterial infections, infecting more than half of the global population. The sensitivity of HP diagnostic tests decreases with the use of antibiotics and/or antisecretory drugs. Given the increasing rates of macrolide resistance worldwide, comprehensive testing for HP eradication is imperative. In this quality improvement project, our focus was on enhancing the diagnosis, treatment, and follow-up of HP infection within our center.
Methods: This is a single-center retrospective observational study using the Electronic Medical Records of patients admitted to our center. We employed a gap analysis approach, including adult patients who were tested from January to June 2023 and compared to prior data from January to December 2021. Using Excel version 2019, we collected data on patient demographics, indications for testing, diagnostic tests, eradication regimens, confirmatory tests, and follow-up.
Results: From January to June 2023, a total of 365 patients were tested using stool antigen, of which 155 (43%) were positive. Participants had a mean age of 51 years, with 64% being female. 46% had a history of antisecretory drugs within two weeks of HP testing, and 3% had taken antibiotics within one month. The most common complaints prompting HP testing included GERD (53%), abdominal pain (50%), dyspepsia (29%), and nausea (10%). From 2021 to 2023, Clarithromycin-based triple therapy remained the most commonly used eradication regimen (76% in 2021, 75% in 2023), while Bismuth-based quadruple therapy usage notably increased (3% in 2021 vs. 17% in 2023). Post-intervention follow-up rates increased from 55% in 2021 to 57% in 2023, with a decrease in the average follow-up time from 17 to 14 weeks. Testing for HP eradication increased from 28% in 2021 to 43% in 2023. In the triple therapy group, 23.4% of patients failed eradication, while in the quadruple therapy group, 6% remained positive post-eradication.
Conclusions: Improved follow-up rates and shorter average follow-up times signify progress in caring for HP-positive patients at our center. Addressing persistently low rates of confirmatory testing is essential, emphasizing the need for better scheduling of follow-up visits to confirm eradication. To enhance ongoing improvement, we plan on implementing quarterly audits, physician education for increased compliance with guideline-recommended eradication regimen, and urea breath testing during visits. The implications of our findings extend beyond the study’s scope, highlighting the potential to reduce gastric cancer incidence and mortality, alongside savings in healthcare costs.