A Study On Iatrogenic Factors Of Helicobacter Pylori Eradication Failure

Part ? Inappropriate use of antibiotics in Helicobacter pylori eradication failureObjective: In recent years,success rates of empirical H.pylori therapies have fallen in many countries.Although antibiotic resistance and poor adherence are described as the main factors for treatment failure,iatrogenic factors also play an important role.This study aimed to investigate why patients experienced multiple failures and to identify causes of treatment failure other than antibiotic resistance.Methods: A retrospective,single center study using questionnaires was performed and patients who experienced multiple failures were collected in digestive outpatient department in Shanghai Renji Hospital from January 2016 to July 2017.Patients with at least two H.pylori treatment failures who completed the questionnaire were entered.The survey covered characteristics of the study population,allergy history,previous antibiotic consumption,endoscopy findings,regimens used,adherence to therapy and hospital prescribed medication.Results: 293 patients were included in the final analysis.Clarithromycincontaining regimens were repeatedly used in 178 patients(60.8%)and levofloxacin-containing regimens repeatedly in 88 patients(30.0%).In nonpenicillin allergy patients,the top three most antibiotic combinations as the first-line treatment were clarithromycin-amoxicillin(26.8%),clarithromycin-metronidazole(23.8%)and clarithromycin-levofloxacin(21.3%).In penicillin allergy patients,the top two most antibiotic combinations as the first-line treatment were clarithromycin-levofloxacin(32.8%)and clarithromycin-metronidazole(27.6%).Eighteen patients(6.1%)stopped treatment because of adverse drug effects per treatment history and 32(10.9%)stopped treatment because of nonmedical reasons.Conclusions: Inappropriate use of antibiotics is widespread in patients who experienced H.pylori eradication failure.To increase the success of H.pylori eradication therapy,the first treatment and the effect of prior therapies need to be given more consideration.Patient education to enhance adherence also needs to be improved.Part ? Correlation of endoscopy findings and Helicobacter Pylori infection and symptoms in patients undergoing the first upper gastrointestinal endoscopyObjective: Endoscopy is currently the best means of finding upper gastrointestinal diseases,especially early cancer and benign ulcers.In China,the infection rate of H.pylori is high,and the incidence of upper gastrointestinal cancer and peptic ulcer is also high.Early detection will have a huge impact on the outcome of disease and the patient's life quality,which has a good cost-effectiveness.This study was to investigate the correlation of endoscopy findings and H.pylori infection and symptoms in patients undergoing the first gastroscopy and to provide reference for the early diagnosis of upper gastrointestinal diseases.Methods: A questionnaires survey was conducted on patients undergoing the first gastroscopy in Renji Hospital from January 2017 to December 2017.Collected patients without any upper digestive surgery had never experienced gastroscopy before and could complete the questionnaires.The survey covered the characteristic of patients,personal history,family history,the main complaint symptoms,duration of symptom and previous gastric medication.Then the data of endoscopy findings,pathological findings and H.pylori infection were recorded.H.pylori infection was determined by any two of positive outcome of the breath test,rapid urease test and histology.Results: 4491 patients were included in the final analysis.The incidence of gastric cancer based on endoscopy was 1.0%,esophageal cancer was 0.3%,peptic ulcer was 11.0%(duodenal ulcer 7.3%,gastric ulcer 2.8%,complex ulcer 0.9%),and chronic gastritis was 86.1%.The infection rate of H.pylori was 33.5%.Endoscopy findings and H.pylori infection had a limited association with major symptoms but not with the duration of symptoms.Patients with dyspepsia and alarm symptoms were found to have an increased risk of peptic ulcer or upper gastrointestinal malignancy compared to asymptomatic patients,with OR of 1.46(95% CI: 1.13~1.89)and 2.59(95% CI :1.74~3.87)respectively.The infection rate of H.pylori was lower in patients with symptoms(except alarm symptoms)compared to asymptomatic patients,with OR of 0.62~ 0.71.Conclusions: Dyspepsia and alarm symptoms are positively associated with major lesions of the upper gastrointestinal tract while they are no positive association with H.pylori infection,so endoscopy can't be ignored due to H.pylori infection.The cost of endoscopy in China is relatively inexpensive.We should pay attention to endoscopy based on individual clinical condition while following guidelines.