AGA issues new clinical practice updates on H. pylori
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The American Gastroenterological Association published a new clinical practice update on the management of refractory Helicobacter pylori.

“Even though only 1% to 3% of infected individuals will develop malignant complications, H. pylori accounts for 15% of the total cancer burden globally, with up to 89% of all gastric cancer attributable to H. pylori infection,” researchers wrote. “Current national and international guidelines provide limited guidance on how to approach factors other than H. pylori antibiotic resistance, which might also underlie eradication failure, such as host- and systems-related factors. Collectively, these issues contribute to persistent H. pylori infection.”

Researchers developed 11 best practice updates on the management of H. pylori after initial eradication failure including advice on regimen selection and consideration of patient factors that contribute to treatment efficacy.

Addressed among the updates from the AGA are:

-- Complex eradication regimens may not be fully comprehended by patients; communicating the rationale for therapy, dosing instructions, expected adverse events and importance of therapy completion is important for successful adherence.
-- Longer treatment durations lead to higher success rates and should be selected when appropriate to bolster eradication.
-- A common cause of refractory H. pylori is antibiotic resistance, other contributing etiologies and prior antibiotic exposures should be explored.
-- In those with a penicillin allergy, experts recommend allergy testing to potentially enable its use.
-- Providers should conduct H. pylori susceptibility testing after two failed eradications with confirmed patient adherence to guide future regimens.

“When considering the major public health implications associated with persistent H. pylori infection with respect to disease and treatment-related complications and cost, there is a clear need to prioritize systematic approaches to improve rates of successful H. pylori eradication with the least number of therapeutic attempts,” researchers concluded.