Study of the Completion of Follow-up After Helicobacter pylori Eradication Therapy

Background: Because no therapeutic regimens have an eradication rate of 100%, post-treatment evaluation is necessary to ensure that adequate eradication therapy for Helicobacter pylori has been provided. The fact that not all patients are evaluated after eradication therapy is a serious concern for both the medical care system and medical economy. Method: We performed a retrospective study of 411 patients who received first-line H. pylori eradication therapy at Fuyoukai Murakami Hospital from October 1, 2014 to March 31, 2016. We calculated the rate of post-treatment follow-up at 1 year after completing the eradication therapy. In addition, we excluded 76 patients who definitely received post-treatment evaluation because of follow-up appointments with gastroenterologists (n = 29) or return visits to other physicians (n = 47) and included 335 patients in the final study population. We used logistic regression models for identifying the relevant factors contributing to the completion of post-eradication follow-up. Results: The rate of completion of post-eradication follow-up was 78.8% (324/411). Multivariate analysis revealed that the adjusted odds ratios for age (≥ 48 years), gender (female) and preventive measures for gastric cancer (esophagogastroduodenoscopy after radiographic screening for gastric cancer and a desire to be examined for H. pylori infection) were 1.85 [95% confidence interval (CI): 1.11–3.09; p < 0.05], 1.89 [95% CI: 1.07–3.34; p < 0.05] and 4.01 [95% CI: 1.61–10.0; p < 0.01], respectively. Conclusion: Age ≥ 48 years, female gender and preventive measures for gastric cancer were independently related to a higher rate of completion of post-eradication follow-up.


INTRODUCTION
eli oba ter pylori infection is associated with both peptic ulcers and gastric cancer, and the International Agency for Research on Cancer has recommended population-based screening and the eradication of H. pylori for controlling gastric cancer. 1,2n Japan, the number of patients receiving H. pylori eradication therapy has been increasing rapidly since the introduction of gastric cancer screening (ABC method) and the recent use of H. pylori eradication therapy for chronic gastritis. 3onoprazan (VPZ), a novel oral potassiumcompetitive acid blocker, was approved for H. pylori eradication by the Japanese health insurance program in 2015, and recent studies have shown that VPZ-H.pylori eradication than does a proton pump inhibitor (PPI)based triple therapy. 4,5Because no therapeutic regimens have an eradication rate of 100%, post-treatment evaluation is necessary to ensure that sufficient eradication therapy for H. pylori has been provided.
However, not all patients are evaluated after receiving eradication therapy.Although patients without posttreatment evaluation should be contacted and invited for a post-eradication follow-up, the medical staffs might be inclined to reduce the load of patient contact.Therefore, we investigated the relevant factors contributing to the completion of post-eradication follow-up.

METHOD
We performed a retrospective study of 411 patients H. pylori eradication therapy at Fuyoukai Murakami Hospital in Aomori city from October 1, 2014 to March 31, 2016.No patients had previously received H. pylori eradication therapy.We used esophagogastroduodenoscopy (EGD) to confirm the absence of malignancy and a rapid urease test to diagnose H. pylori infection.One of two gastroenterologists initiated H. pylori eradication therapy and used a 13 C-urea breath test (UBT) for the evaluation of H. pylori eradication.The subjects were instructed to visit Fuyoukai Murakami Hospital for a post-eradication test at > 2 months after completing the therapy and to avoid taking PPIs, VPZ, antibiotics, ecabet sodium and polaprezinc within 2 weeks of evaluating eradication due to the likelihood of falsenegative results in the UBT. 6,7e calculated the rate of post-treatment followup at 1 year after completing the eradication therapy.received post-treatment evaluation because of follow-up appointments with gastroenterologists (n = 29) or return visits to other physicians (n = 47) We used logistic regression models for identifying the relevant factors that contributed to the completion of posteradication follow-up and sequentially introduced six of dyspepsia and preventive measures for gastric cancer (EGD after radiographic screening for gastric cancer and a desire for the diagnosis of H. pylori infection)-into the model.The abovementioned cut-off value for age at the completion of post-eradication evaluation was obtained = 60.9%) in the receiver operating characteristic curve interval (CI): 0.528-0.668].
The present study was approved by the institutional ethics committee, and informed consent was obtained from the patients.We conducted all statistical analyses Yusaku Kajihara, Tadashi Shimoyama

RESULTS
The rate of completion of follow-up after H. pylori eradication therapy was 78.8% (324/411).The patients' Table 1.The median age was 48 years; the median ages of those in complete and incomplete groups were 50 years (range, 14-76 years) and 44 years (range, 21-79 years), respectively.
Multivariate analysis revealed that the adjusted preventive measures for gastric cancer were 1.85 (95% respectively (Table 2).

DISCUSSION
In the present study, the rate of patients who underwent a post-treatment examination to determine H. pylori eradication therapy was 33% higher than the value (45.7%; 48/105) reported in a Danish study; however, the patients' backgrounds differed between the two studies. 9Furthermore, a Canadian study reported that patients who had a formal follow-up appointment were more likely to complete the therapy [96.3% (77/80) vs. 50.0%(11/22)]. 10In the present study, all 29 patients who were excluded from eradication evaluation.Thus, it is very important to make a follow-up appointment for increasing the posteradication evaluation rate.Additionally, UBT is the H. pylori eradication, and the monoclonal stool antigen test (SAT) is a suitable alternative. 11e performed at least 4-8 weeks after the completion of H. pylori eradication therapy. 11e performed a UBT at least 2 months after the completion of treatment to minimize the likelihood of false-negative results.However, it became more initiation of H. pylori eradication therapy, and only Study of the Completion of Follow-up After Helicobacter pylori Eradication Therapy 7.1% of the overall study population (29/411) received follow-up appointments in the present study.Although patients need to be cautious of the temperature for sample preservation and avoid the collection of a watery stool sample while performing the SAT, the provision of an SAT kit when introducing H. pylori eradication therapy might increase the motivation the SAT is that the patients are not required to fast on the morning of the appointed day.In Japan, an SAT comprising an immunochromatographic assay (Rapid Testmate Pylori Antigen , Wakamoto Pharmaceutical, and the results can be rapidly obtained on the day of examination. 12he fact that not all patients are evaluated after receiving eradication therapy is a serious concern for both the medical care system and medical economy.therapy leads to wasted medical expenditures related to diagnosis and treatment [i.e.> 10000 Japanese yen (JPY) or 91 US dollars (USD) per patient are wasted; 1 USD = 110 JPY].If H. pylori-associated diseases, including peptic ulcers and gastric cancer, occur in the failure group without follow-up, the amount of wasted medical expenditures is increased.Approximately 1.5 million people per year are estimated to receive H. pylori eradication therapy in Japan; therefore, a large amount of the money spent on health insurance could be wasted. 13In addition, the annual reinfection rate after successful H. pylori eradication was reported to be 0.22-2.0% in Japan. 14,15If H. pylori infection is diagnosed in a patient who has not undergone post-eradication tests for H. pylori, it is impossible H. pylori eradication therapies are approved by the to select the appropriate therapeutic regimen in such cases.
48 years, female gender and preventive measures for gastric cancer were independently related to a higher rate of completion of post-eradication follow-up.The concern regarding post-treatment evaluation is relatively stronger among patients with any relevant factors, and the application of preventive measures for gastric cancer has the greatest impact on the completion of post-eradication evaluation.Particularly, of the 12 patients who wished to be examined for H. pylori infection, 11 (91.7%)patients received post-treatment the desire to be assessed for H. pylori infection most highly motivated patients to evaluate the results of their eradication therapy.Contrary to expectation, presence of dyspepsia was not a relevant factor; this may be because resolution of the symptom due to the treatment might have decreased the motivation for post-treatment follow-up.The Japanese Society for Helicobacter Research has stated that any 'H.pylori infection' is considered as the indication for eradication, irrespective of the background diseases. 1n countries, such as Japan, with a high prevalence of H. pylori infection and gastric cancer, H. pylori eradication accompanied with active screening is recommended for young people.The importance of post-treatment evaluation, particularly among emphasized in a screening test.
The present study had several limitations.First, this was a single-center study.Second, the patients' completion of follow-up after H. pylori eradication therapy; however, these data were unavailable in the patients' electronic medical records.Furthermore, statistical analyses after adjustment for numerous confounding factors, including the patients' social and clinical characteristics, could not be conducted.

CONCLUSION
measures for gastric cancer were independently related to a higher rate of completion of post-eradication follow-up.