Helicobacter pylori-associated peptic ulcer disease: A retrospective analysis of post-treatment testing practices
Helicobacter pylori-associated peptic ulcer disease: A retrospective analysis of post-treatment testing practices
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DOI：
10.1111/hel.12540
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发表时间：
2018-12-01
期刊：
影响因子：
4.4
通讯作者：
Garman, Katherine S.
中科院分区：
文献类型：
--
作者：
Feder, Rachel;Posner, Shai;Garman, Katherine S.
背景与目的指南建议幽门螺杆菌(Hp)相关性消化性溃疡(PUD)患者接受幽门螺杆菌根除治疗，然后进行治疗后检测以证明根除；然而，治疗后检测率并不理想，检测障碍也知之甚少。我们的目的是确定预测接受治疗后检测的因素。结果我们对2007年至2015年在美国某大型三级医学中心确诊的152例幽门螺杆菌相关性PUD患者进行了回顾性队列研究，这些患者在一年内接受了标准的根除治疗和动态随访。感兴趣的主要结果是接受治疗后测试。Logistic回归模型比较了门诊患者与住院患者、没有重复内窥镜检查的患者以及没有胃肠病(GI)临床随访的患者的治疗后测试率。倾向性得分控制在年龄、性别、种族、溃疡部位和症状持续时间。在152名患者中，67名患者(44%)接受了治疗后测试。被诊断为门诊患者和住院患者的治疗后检测率差异有统计学意义(57%比33%；OR3.87，P=0.001)；在VS患者中没有胃肠道随访的患者(62%比11%；OR9.85，P<；0.0001)。结论幽门螺杆菌相关性PUD患者治疗后的根治率较低。然而，在接受胃肠道疾病随访并在门诊诊断的患者中，这一点得到了显著改善。我们的研究为质量改进计划提供了一个明确的机会。
Background & Aims Guidelines recommend that patients with Helicobacter pylori (H. pylori)-associated peptic ulcer disease (PUD) receive H. pylori eradication therapy followed by post-treatment testing to prove eradication; however, post-treatment testing rates are suboptimal and barriers to testing are poorly understood. Our aim was to identify factors that predicted receipt of post-treatment testing. Methods Results We performed a retrospective cohort study of 152 patients with H. pylori-associated PUD diagnosed between 2007 and 2015 at a large tertiary medical center in the United States, who received standard eradication therapy and ambulatory follow-up within one year. The primary outcome of interest was receipt of post-treatment testing. Logistic regression models compared post-treatment testing rates in those diagnosed while outpatient vs inpatient, patients with vs without repeat endoscopy, and patients with vs without gastroenterology (GI) clinic follow-up. Propensity scores controlled for age, sex, race, ulcer location, and symptom persistence. Among 152 patients, 67 (44%) patients received post-treatment testing. There were significant differences in post-treatment testing rates in those diagnosed as outpatients vs inpatients (57% vs 33%; OR 3.87, P = 0.001) and in patients with vs without GI follow-up (62% vs 11%; OR 9.85, P < 0.0001). Conclusions The rate of testing for eradication after treatment in patients with H. pylori- associated PUD was low. However, this was significantly improved in patients who have GI follow-up and whose diagnosis was made in the outpatient setting. Our study demonstrates a clear opportunity for quality improvement initiatives.