Lack of symptom benefit following presumptive Helicobacter pylori eradication therapy in primary care

Background: Helicobacter pylori eradication regimens have failure rates under 10%, however little information is available on the effect of treatment success in reducing the subsequent prescription of anti-ulcer medications in primary care.

Aims: To determine, using a large prescription database in eastern Ireland, the success of presumptive eradication therapy in improving symptoms of dyspepsia in primary care, as judged by a reduction in the subsequent prescription of anti-ulcer medications.

Methods: In a cross-sectional study, we identified 3847 patients who received a prescription for eradication therapy for Helicobacter pylori, including 826 who were followed for 9-11 months. Those who subsequently received anti-ulcer medications were deemed failures to obtain symptom relief.

Results: For 3847 patients with a median follow-up of 8 months, the failure rate was 49%. Of 826 patients, followed for a longer period (9-11 months), the overall failure rate was 56% (range 44-62% depending on the eradication regimen used). Age over 65 years (hazard ratio = 1.57, 95% confidence interval = 1.29-1.91, P<0.001), prior use of anti-ulcer medications (hazard ratio = 1.97, 95% confidence interval = 1.63-2.37, P<0.001) and prior use of aspirin/NSAIDs (hazard ratio = 1.43, 95% confidence interval = 1.18-1.73, P<0.001) all predicted failure to obtain relief of symptoms of dyspepsia from eradication therapy.

Conclusions: Such high failure rates of eradication therapy in reducing the subsequent consumption of anti-ulcer medications have both clinical and economic implications for the use of eradication therapy for Helicobacter pylori in primary care.