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Female Gender is the Only Significant Clinical Predictor for Abnormal Pharyngeal Reflux on Impedance-pH Monitoring in Patients with Suspected Laryngopharyngeal Reflux Symptoms
Sa1172
Background: Idiopathic pulmonary fibrosis (IPF) is a universally fatal lung disease with limited medical therapeutic options. Gastroesophageal reflux disease (GERD) has been shown to be a putative risk factor in the pathogenesis of IPF, although the mechanism is poorly understood. Current guidelines from the American Thoracic Society suggest the conditional use of proton pump inhibition (PPI) for the management of IPF patients. However, there is a lack of strong evidence to support this recommendation, as prior studies have demonstrated mixed results. Aim: To perform a meta-analysis and systematic review of existing literature on the effect of PPI on survival and other clinical outcomes in IPF patients. Methods: Clinical studies of adult patients with IPF with data comparing mortality of PPI users versus non-users were identified using MEDLINE/PubMed, EMBASE, and Cochrane Central Register of Controlled Trials through November 2016. Two reviewers independently extracted data on study characteristics and outcomes. For the meta-analysis, the primary metameter was the hazard ratio (HR) for survival among PPI users versus non-users. Random effects model was used due to anticipated heterogeneity. Additional outcomes reviewed included change in pulmonary function, 6-minute walk distance, and hospital readmission rates. Results: Five studies (n=3742) met inclusion criteria. The pooled HR in PPI users versus nonusers was 0.74 (95% Confidence Interval: 0.40, 1.39). No significant single large study or temporal effect was seen. Only one study reported additional pulmonary outcomes, and none were impacted by PPI use. Significant heterogeneity of studies was noted (Figure 1). Conclusions: PPI use was not associated with statistically significant increase in survival in IPF patients, although a trend towards improved survival was noted. PPI therapy solely targets acid rather than bolus reflux which may explain this finding. Additionally, the significant heterogeneity across studies likely contributes to confounding. However, based on this data, universal PPI use in IPF patients with the goal to improve pulmonary and survival outcomes does not seem to be supported. Future studies should aim to better understand the pathophysiology of GERD and the potential role of PPI therapy in IPF to help guide management of this difficult patient population.
Figure 2
Sa1171 DIFFERENCES IN MOTILITY AND REFLUX PROFILES ON ESOPHAGEAL FUNCTION TESTING BETWEEN UPPER AND LOWER AIRWAY MANIFESTATIONS OF GASTROESOPHAGEAL REFLUX DISEASE Wai-Kit Lo, Lawrence F. Borges, Kelly Hathorn, Thomas L. Carroll, Hilary J. Goldberg, Robert Burakoff, Natan Feldman, Walter W. Chan Background: Gastroesophageal reflux disease (GERD) may present with extra-esophageal manifestations involving the upper airway [laryngo-pharyngeal reflux (LPR)] and lower airway [chronic lung disease (CLD)]. While some clinical symptoms may overlap, the consequences of lower airway reflux are more severe and may suggest a different pattern/ severity of reflux involvement. The esophageal function and reflux profiles of upper vs lower airway symptoms on objective testing are currently unclear, but may help understand the pathophysiology of extra-esophageal manifestations of GERD and guide further management. Aim: To compare the esophageal function and reflux profiles of LPR and CLD patients undergoing high resolution esophageal manometry (HRM) and multichannel intraluminal impedance and pH testing (MII-pH) for assessment of symptoms. Methods: This was a retrospective cohort study of patients with LPR symptoms or CLD (excluding autoimmune etiologies) who underwent HRM and MII-pH off acid suppression at a tertiary center since 2008. Patients with prior antireflux surgery were excluded. Patient demographics, clinical history, and HRM/MII-pH findings were reviewed. Fisher's exact test for binary variables and student's t-test for continuous variables were performed to assess for differences between LPR and CLD groups. Results: 149 subjects (53% LPR vs 47% CLD, 45% male, mean age at testing: 56) met inclusion criteria for the study. Compared to LPR patients, CLD subjects presenting for esophageal function testing were more likely to be male (61.4% vs 30.3%, p=0.0002) and demonstrated more severe reflux parameters, including abnormal acid exposure time (24.3% vs 8.4%, p=0.01), total reflux episodes (59.9 vs 45.1, p=0.008), and proximal acid reflux episodes (13.7 vs 3.14, p<0.0001). The mean nocturnal baseline impedance, a novel measure of esophageal mucosal integrity, was also lower in the CLD group (1927.5 ohms vs 2441.4 ohms), suggesting more severe reflux, although statistical significance was not reached. Higher proportion of weak swallows, defined as distal contractile integral 100-450 mmHg.cm.s, were noted on HRM among CLD patients compared to the LPR group (18% vs 5.88%, p=0.03). Conclusion: In a cohort of patients with LPR symptoms or CLD undergoing esophageal function testing, male gender, abnormal parameters of acid reflux on MII-pH, and weak swallows on HRM were significantly more prevalent in patients with CLD compared to LPR. Reflux and its consequences may be more prevalent and more severe in lower airway manifestations of GERD compared to upper airway symptoms. Earlier esophageal function testing and reflux intervention may be indicated in patients with suspected lower airway manifestations of GERD. Future studies should focus on the role of reflux and esophageal function testing in guiding clinical management in this population.
Figure 1. Forest plot of all included studies demonstrating trend towards improved survival with PPI use in IPF patients.
Sa1173 FEMALE GENDER IS THE ONLY SIGNIFICANT CLINICAL PREDICTOR FOR ABNORMAL PHARYNGEAL REFLUX ON IMPEDANCE-PH MONITORING IN PATIENTS WITH SUSPECTED LARYNGOPHARYNGEAL REFLUX SYMPTOMS Kelly Hathorn, Lawrence F. Borges, Thomas L. Carroll, Natan Feldman, Walter W. Chan Background: Patients with suspected laryngopharyngeal reflux (LPR) symptoms pose a diagnostic challenge, as traditional reflux testing modalities have been inconsistent in identifying patients who may respond to anti-reflux therapy. Modified multichannel intraluminal impedance and pH (MII-pH) catheters with additional impedance electrode pairs in the hypopharynx have been developed to better identify full-column reflux events affecting the pharynx. Despite the new technologies, little is known about the demographic and clinical characteristics associated with increased risk of abnormal pharyngeal reflux events. A better understanding of the patient factors influencing risk of frequent pharyngeal events may improve our ability to diagnose and manage LPR. Aim: To determine demographic or clinical factors that are associated with increased pharyngeal reflux events in patients with suspected LPR. Methods: This was a retrospective cohort study of adults with suspected LPR who underwent MII-pH with additional pharyngeal impedance channels from 4/2015 to 10/ 2016. Demographic and clinical information were collected for each patient, including age, gender, BMI, smoking history, history of esophageal reflux symptoms, and medication use. Forward stepwise logistic regression was used to identify significant predictive factors for abnormal pharyngeal reflux (defined as ≥ 2 pharyngeal impedance events / 24 hours). Results: 60 subjects (mean age = 55.5 yrs, 71.7% female) met criteria for inclusion. 17 (28.3%) were tested while on proton pump inhibitors. Overall, 39 subjects (65%) were found to have abnormal pharyngeal reflux on impedance. Of them, 30 (76.9%) were women, mean BMI was 27.5+/-5.6, 12 (30.8%) were former smokers, and 3 (7.7%) had a history of narcotic or benzodiazepine use. On multivariate analysis, female gender (OR 6.29, p= 0.04) was the only factor that remained significantly associated with abnormal pharyngeal reflux, after controlling for potential confounders. Conclusion: Among patients with suspected LPR symptoms undergoing MII-pH with pharyngeal impedance channels, female gender was the only independent positive predictor for abnormal pharyngeal reflux events. Whether this represents a true increase in LPR prevalence among female patients, or different
Table 1. Demographics, MII-pH, and HREM parameters that may help distinguish LPR from CLD. Missing data in some patients may alter the N in the denominator, as specified in the table. MII-pH = multichannel intraluminal impedance and pH; HREM = high resolution esophageal manometry; LPR = laryngopharyngeal reflux; CLD = chronic lung disease; AET = acid exposure time; SD = standard deviation; NS = not significant.
S-243
AGA Abstracts
AGA Abstracts
EFFECT OF PROTON PUMP INHIBITION ON SURVIVAL IN PATIENTS WITH IDIOPATHIC PULMONARY FIBROSIS: A META-ANALYSIS AND SYSTEMATIC REVIEW Sravanya Gavini, Wai-Kit Lo, Lawrence F. Borges, Alison Goldin, Walter W. Chan
AGA Abstracts
health care-seeking behavior in this population, requires further evaluation. No other clinical or demographic factors reliably identified patients with objective signs of increased pharyngeal reflux. Objective reflux testing using MII-pH with additional pharyngeal impedance monitoring should be considered when evaluating patients with suspected LPR symptoms.
Sa1175 INCREASED HELICOBACTER PYLORI UREASE ACTIVITY IS ASSOCIATED WITH SUCCESSFUL ERADICATION IN A "TEST-AND-TREAT" POPULATION-BASED COHORT Doron Boltin, Zohar Levi, Tsachi Tsadok Perets, Hemda Schmilovitz-Weiss, Rachel Gingold-Belfer, Ram Dickman, Yaron Niv
Sa1174
Background: There are continual efforts to identify factors which influence the success of first-line therapy for Helicobacter pylori (H. pylori) infection. The C13-urea breath test result (C13-UBT) utilizes H. pylori urease activity and is a highly accurate diagnostic assay. No studies have been performed investigating whether the magnitude of C13-UBT result is related to treatment success. Methods: Adult patients who underwent a first-time C13-urea breath test between January 2010 and January 2016 were included. In order to isolate a naïve test-and-treat population who were unlikely to have undergone an initial endoscopybased H. pylori test, we excluded patients >45 years and those with any previous C13-UBT. Data were extracted from the Clalit Health Services laboratory database. Results: A total of 94,590 subjects (36.1% male, age 28.5±6.0 years) who underwent a first-time C13-UBT during the study period were included. C13-UBT was positive in 48,509 (51.3%) subjects. A confirmatory post-treatment C13-UBT was performed in 18,375 (37.8%) and eradication was successful in 12,018 (65.4%). The mean C13-UBT recording was 20.6±16.2 δ/mL in subjects with successful eradication and 19.5±13.1 δ/mL in subjects with treatment failure (OR, 1.005; 95%CI 1.003-1.008, p<0.0001). Among patients in the lower quintile of C13UBT measurement, eradication was achieved in 63.0%, compared to 67.6% in the upper quintile (OR, 0.82; 95%CI 0.74-0.90, p<0.0001). Patients with C13-UBT <70 δ/mL achieved eradication in 65.3%, compared to 75.0% among subjects in the top 1 percentile with C13UBT ≥70 δ/mL (OR, 0.63; 95%CI 0.42-0.95, p<0.01). Conclusions: The superiority in H. pylori eradication observed in subjects with a higher C13-UBT δ/mL is small but significant. Further studies should examine the microbiological basis for this finding.
TEMPORAL TRENDS IN HELICOBACTER PYLORI ERADICATION SUCCESS IN A TEST-AND-TREAT POPULATION- A NATIONWIDE COHORT STUDY Doron Boltin, Zohar Levi, Hemda Schmilovitz-Weiss, Rachel Gingold-Belfer, Tsachi Tsadok Perets, Ram Dickman, Yaron Niv Background: Although the efficacy of first-line treatment for Helicobacter pylori (H. pylori) infection should aim to be >90%, it is unclear whether this target has been achieved in our region. We aimed to determine the success rate of treatment for H. pylori and to describe temporal changes in our region. Methods: Adult patients who underwent a first-time C13urea breath test (C13-UBT) between January 2010 and January 2016 were included. In order to isolate a naïve "test-and-treat" population who were unlikely to have undergone an initial endoscopy-based H. pylori test, we excluded patients >45 years and those with any previous C13-UBT. Patients who underwent a C13-UBT following a negative test were excluded. Data were extracted from the Clalit Health Services laboratory database. Results: A total of 94,590 subjects (36.1% male, age 28.5±6.0 years) who underwent at least one C13-UBT during the study period were included. C13-UBT was positive in 48,509 (51.3%) subjects. A confirmatory post-treatment C13-UBT was performed in 37.8%, 44.1%, 46.6% and 45.9% following 1st, 2nd, 3rd and 4th-line treatment, respectively. Eradication was successful in 65.4% following 1st-line treatment, and eradication success improved during the study period (59.2%, 63.3%, 65.7%, 66.0%, 69.0% and 73.1% in 2010, 2011, 2012, 2013, 2014 and 2015, respectively) (OR, 1.11; 95%CI, 1.09-1.13; p<0.0001). Eradication was successful in 44.7% following 2nd-line treatment, although eradication success did not significantly improve during the study period (43.6%, 44.6%, 42.3%, 45.1%, 46.7% and 54.9% in 2010, 2011, 2012, 2013, 2014 and 2015, respectively) (OR, 1.05; 95%CI, 0.99-1.10; p=0.09). Conclusions: Despite the increasing success of 1st-line treatment for H. pylori infection over the study period, eradication rates remain suboptimal. Initiatives to implement the Toronto and Maastricht Consensus Reports should be advanced.
H. pylori eradication success according to the magnitude of C13-urea breath test by quintile
Table 1, C13-UBT positivity following repeated eradication attempts, 2010-2015.
H. pylori eradication success in subjects with C13-urea breath test measurement ≥70 δ/mL
Sa1176 MULTI-CENTER PROSPECTIVE, TEST AND TREAT: STUDY ON HELICOBACTER PYLORI FOR HIGH SCHOOL STUDENTS IN KYOTO PREFECTURE Osamu Handa, Yuji Naito, Atsushi Majima, Rieko Mukai, Yosuke Suyama, Saori Kashiwagi, Takahiro Nakano, Takaaki Murakami, Yuki Toyokawa, Tomohiro Ueda, Katsura Mizushima, Akifumi Fukui, Osamu Dohi, Naohisa Yoshida, Kazuhiro Kamada, Kazuhiro Katada, Kazuhiko Uchiyama, Tomohisa Takagi, Hideyuki Konishi, Yoshito Itoh
st
Background In Japan, a country with high incident of gastric cancer, to reduce the infection rate of Helicobacter pylori (HP) is important to reduce gastric cancer death. It has been reported that the eradication at an early stage of HP infection is effective in preventing HPrelated gastric carcinogenesis in a rat model. Even in human, HP eradication therapy for the younger generation is thought to be much more effective for the primary prevention of gastric carcinogenesis than that for the elder generation. As a part of the gastric cancer elimination project in Kyoto Prefecture, multi-center prospective "test and treat" study on HP for high school students was carried out from April 2015. Aim The aim of this study is to investigate the time trend of HP infection rate in high school student, and to know
nd
Successful eradication of Helicobacter pylori following 1 and 2 -line antibiotic therapy
AGA Abstracts
S-244
Background: Idiopathic pulmonary fibrosis (IPF) is a universally fatal lung disease with limited medical therapeutic options. Gastroesophageal reflux disease (GERD) has been shown to be a putative risk factor in the pathogenesis of IPF, although the mechanism is poorly understood. Current guidelines from the American Thoracic Society suggest the conditional use of proton pump inhibition (PPI) for the management of IPF patients. However, there is a lack of strong evidence to support this recommendation, as prior studies have demonstrated mixed results. Aim: To perform a meta-analysis and systematic review of existing literature on the effect of PPI on survival and other clinical outcomes in IPF patients. Methods: Clinical studies of adult patients with IPF with data comparing mortality of PPI users versus non-users were identified using MEDLINE/PubMed, EMBASE, and Cochrane Central Register of Controlled Trials through November 2016. Two reviewers independently extracted data on study characteristics and outcomes. For the meta-analysis, the primary metameter was the hazard ratio (HR) for survival among PPI users versus non-users. Random effects model was used due to anticipated heterogeneity. Additional outcomes reviewed included change in pulmonary function, 6-minute walk distance, and hospital readmission rates. Results: Five studies (n=3742) met inclusion criteria. The pooled HR in PPI users versus nonusers was 0.74 (95% Confidence Interval: 0.40, 1.39). No significant single large study or temporal effect was seen. Only one study reported additional pulmonary outcomes, and none were impacted by PPI use. Significant heterogeneity of studies was noted (Figure 1). Conclusions: PPI use was not associated with statistically significant increase in survival in IPF patients, although a trend towards improved survival was noted. PPI therapy solely targets acid rather than bolus reflux which may explain this finding. Additionally, the significant heterogeneity across studies likely contributes to confounding. However, based on this data, universal PPI use in IPF patients with the goal to improve pulmonary and survival outcomes does not seem to be supported. Future studies should aim to better understand the pathophysiology of GERD and the potential role of PPI therapy in IPF to help guide management of this difficult patient population.
Figure 2
Sa1171 DIFFERENCES IN MOTILITY AND REFLUX PROFILES ON ESOPHAGEAL FUNCTION TESTING BETWEEN UPPER AND LOWER AIRWAY MANIFESTATIONS OF GASTROESOPHAGEAL REFLUX DISEASE Wai-Kit Lo, Lawrence F. Borges, Kelly Hathorn, Thomas L. Carroll, Hilary J. Goldberg, Robert Burakoff, Natan Feldman, Walter W. Chan Background: Gastroesophageal reflux disease (GERD) may present with extra-esophageal manifestations involving the upper airway [laryngo-pharyngeal reflux (LPR)] and lower airway [chronic lung disease (CLD)]. While some clinical symptoms may overlap, the consequences of lower airway reflux are more severe and may suggest a different pattern/ severity of reflux involvement. The esophageal function and reflux profiles of upper vs lower airway symptoms on objective testing are currently unclear, but may help understand the pathophysiology of extra-esophageal manifestations of GERD and guide further management. Aim: To compare the esophageal function and reflux profiles of LPR and CLD patients undergoing high resolution esophageal manometry (HRM) and multichannel intraluminal impedance and pH testing (MII-pH) for assessment of symptoms. Methods: This was a retrospective cohort study of patients with LPR symptoms or CLD (excluding autoimmune etiologies) who underwent HRM and MII-pH off acid suppression at a tertiary center since 2008. Patients with prior antireflux surgery were excluded. Patient demographics, clinical history, and HRM/MII-pH findings were reviewed. Fisher's exact test for binary variables and student's t-test for continuous variables were performed to assess for differences between LPR and CLD groups. Results: 149 subjects (53% LPR vs 47% CLD, 45% male, mean age at testing: 56) met inclusion criteria for the study. Compared to LPR patients, CLD subjects presenting for esophageal function testing were more likely to be male (61.4% vs 30.3%, p=0.0002) and demonstrated more severe reflux parameters, including abnormal acid exposure time (24.3% vs 8.4%, p=0.01), total reflux episodes (59.9 vs 45.1, p=0.008), and proximal acid reflux episodes (13.7 vs 3.14, p<0.0001). The mean nocturnal baseline impedance, a novel measure of esophageal mucosal integrity, was also lower in the CLD group (1927.5 ohms vs 2441.4 ohms), suggesting more severe reflux, although statistical significance was not reached. Higher proportion of weak swallows, defined as distal contractile integral 100-450 mmHg.cm.s, were noted on HRM among CLD patients compared to the LPR group (18% vs 5.88%, p=0.03). Conclusion: In a cohort of patients with LPR symptoms or CLD undergoing esophageal function testing, male gender, abnormal parameters of acid reflux on MII-pH, and weak swallows on HRM were significantly more prevalent in patients with CLD compared to LPR. Reflux and its consequences may be more prevalent and more severe in lower airway manifestations of GERD compared to upper airway symptoms. Earlier esophageal function testing and reflux intervention may be indicated in patients with suspected lower airway manifestations of GERD. Future studies should focus on the role of reflux and esophageal function testing in guiding clinical management in this population.
Figure 1. Forest plot of all included studies demonstrating trend towards improved survival with PPI use in IPF patients.
Sa1173 FEMALE GENDER IS THE ONLY SIGNIFICANT CLINICAL PREDICTOR FOR ABNORMAL PHARYNGEAL REFLUX ON IMPEDANCE-PH MONITORING IN PATIENTS WITH SUSPECTED LARYNGOPHARYNGEAL REFLUX SYMPTOMS Kelly Hathorn, Lawrence F. Borges, Thomas L. Carroll, Natan Feldman, Walter W. Chan Background: Patients with suspected laryngopharyngeal reflux (LPR) symptoms pose a diagnostic challenge, as traditional reflux testing modalities have been inconsistent in identifying patients who may respond to anti-reflux therapy. Modified multichannel intraluminal impedance and pH (MII-pH) catheters with additional impedance electrode pairs in the hypopharynx have been developed to better identify full-column reflux events affecting the pharynx. Despite the new technologies, little is known about the demographic and clinical characteristics associated with increased risk of abnormal pharyngeal reflux events. A better understanding of the patient factors influencing risk of frequent pharyngeal events may improve our ability to diagnose and manage LPR. Aim: To determine demographic or clinical factors that are associated with increased pharyngeal reflux events in patients with suspected LPR. Methods: This was a retrospective cohort study of adults with suspected LPR who underwent MII-pH with additional pharyngeal impedance channels from 4/2015 to 10/ 2016. Demographic and clinical information were collected for each patient, including age, gender, BMI, smoking history, history of esophageal reflux symptoms, and medication use. Forward stepwise logistic regression was used to identify significant predictive factors for abnormal pharyngeal reflux (defined as ≥ 2 pharyngeal impedance events / 24 hours). Results: 60 subjects (mean age = 55.5 yrs, 71.7% female) met criteria for inclusion. 17 (28.3%) were tested while on proton pump inhibitors. Overall, 39 subjects (65%) were found to have abnormal pharyngeal reflux on impedance. Of them, 30 (76.9%) were women, mean BMI was 27.5+/-5.6, 12 (30.8%) were former smokers, and 3 (7.7%) had a history of narcotic or benzodiazepine use. On multivariate analysis, female gender (OR 6.29, p= 0.04) was the only factor that remained significantly associated with abnormal pharyngeal reflux, after controlling for potential confounders. Conclusion: Among patients with suspected LPR symptoms undergoing MII-pH with pharyngeal impedance channels, female gender was the only independent positive predictor for abnormal pharyngeal reflux events. Whether this represents a true increase in LPR prevalence among female patients, or different
Table 1. Demographics, MII-pH, and HREM parameters that may help distinguish LPR from CLD. Missing data in some patients may alter the N in the denominator, as specified in the table. MII-pH = multichannel intraluminal impedance and pH; HREM = high resolution esophageal manometry; LPR = laryngopharyngeal reflux; CLD = chronic lung disease; AET = acid exposure time; SD = standard deviation; NS = not significant.
S-243
AGA Abstracts
AGA Abstracts
EFFECT OF PROTON PUMP INHIBITION ON SURVIVAL IN PATIENTS WITH IDIOPATHIC PULMONARY FIBROSIS: A META-ANALYSIS AND SYSTEMATIC REVIEW Sravanya Gavini, Wai-Kit Lo, Lawrence F. Borges, Alison Goldin, Walter W. Chan
AGA Abstracts
health care-seeking behavior in this population, requires further evaluation. No other clinical or demographic factors reliably identified patients with objective signs of increased pharyngeal reflux. Objective reflux testing using MII-pH with additional pharyngeal impedance monitoring should be considered when evaluating patients with suspected LPR symptoms.
Sa1175 INCREASED HELICOBACTER PYLORI UREASE ACTIVITY IS ASSOCIATED WITH SUCCESSFUL ERADICATION IN A "TEST-AND-TREAT" POPULATION-BASED COHORT Doron Boltin, Zohar Levi, Tsachi Tsadok Perets, Hemda Schmilovitz-Weiss, Rachel Gingold-Belfer, Ram Dickman, Yaron Niv
Sa1174
Background: There are continual efforts to identify factors which influence the success of first-line therapy for Helicobacter pylori (H. pylori) infection. The C13-urea breath test result (C13-UBT) utilizes H. pylori urease activity and is a highly accurate diagnostic assay. No studies have been performed investigating whether the magnitude of C13-UBT result is related to treatment success. Methods: Adult patients who underwent a first-time C13-urea breath test between January 2010 and January 2016 were included. In order to isolate a naïve test-and-treat population who were unlikely to have undergone an initial endoscopybased H. pylori test, we excluded patients >45 years and those with any previous C13-UBT. Data were extracted from the Clalit Health Services laboratory database. Results: A total of 94,590 subjects (36.1% male, age 28.5±6.0 years) who underwent a first-time C13-UBT during the study period were included. C13-UBT was positive in 48,509 (51.3%) subjects. A confirmatory post-treatment C13-UBT was performed in 18,375 (37.8%) and eradication was successful in 12,018 (65.4%). The mean C13-UBT recording was 20.6±16.2 δ/mL in subjects with successful eradication and 19.5±13.1 δ/mL in subjects with treatment failure (OR, 1.005; 95%CI 1.003-1.008, p<0.0001). Among patients in the lower quintile of C13UBT measurement, eradication was achieved in 63.0%, compared to 67.6% in the upper quintile (OR, 0.82; 95%CI 0.74-0.90, p<0.0001). Patients with C13-UBT <70 δ/mL achieved eradication in 65.3%, compared to 75.0% among subjects in the top 1 percentile with C13UBT ≥70 δ/mL (OR, 0.63; 95%CI 0.42-0.95, p<0.01). Conclusions: The superiority in H. pylori eradication observed in subjects with a higher C13-UBT δ/mL is small but significant. Further studies should examine the microbiological basis for this finding.
TEMPORAL TRENDS IN HELICOBACTER PYLORI ERADICATION SUCCESS IN A TEST-AND-TREAT POPULATION- A NATIONWIDE COHORT STUDY Doron Boltin, Zohar Levi, Hemda Schmilovitz-Weiss, Rachel Gingold-Belfer, Tsachi Tsadok Perets, Ram Dickman, Yaron Niv Background: Although the efficacy of first-line treatment for Helicobacter pylori (H. pylori) infection should aim to be >90%, it is unclear whether this target has been achieved in our region. We aimed to determine the success rate of treatment for H. pylori and to describe temporal changes in our region. Methods: Adult patients who underwent a first-time C13urea breath test (C13-UBT) between January 2010 and January 2016 were included. In order to isolate a naïve "test-and-treat" population who were unlikely to have undergone an initial endoscopy-based H. pylori test, we excluded patients >45 years and those with any previous C13-UBT. Patients who underwent a C13-UBT following a negative test were excluded. Data were extracted from the Clalit Health Services laboratory database. Results: A total of 94,590 subjects (36.1% male, age 28.5±6.0 years) who underwent at least one C13-UBT during the study period were included. C13-UBT was positive in 48,509 (51.3%) subjects. A confirmatory post-treatment C13-UBT was performed in 37.8%, 44.1%, 46.6% and 45.9% following 1st, 2nd, 3rd and 4th-line treatment, respectively. Eradication was successful in 65.4% following 1st-line treatment, and eradication success improved during the study period (59.2%, 63.3%, 65.7%, 66.0%, 69.0% and 73.1% in 2010, 2011, 2012, 2013, 2014 and 2015, respectively) (OR, 1.11; 95%CI, 1.09-1.13; p<0.0001). Eradication was successful in 44.7% following 2nd-line treatment, although eradication success did not significantly improve during the study period (43.6%, 44.6%, 42.3%, 45.1%, 46.7% and 54.9% in 2010, 2011, 2012, 2013, 2014 and 2015, respectively) (OR, 1.05; 95%CI, 0.99-1.10; p=0.09). Conclusions: Despite the increasing success of 1st-line treatment for H. pylori infection over the study period, eradication rates remain suboptimal. Initiatives to implement the Toronto and Maastricht Consensus Reports should be advanced.
H. pylori eradication success according to the magnitude of C13-urea breath test by quintile
Table 1, C13-UBT positivity following repeated eradication attempts, 2010-2015.
H. pylori eradication success in subjects with C13-urea breath test measurement ≥70 δ/mL
Sa1176 MULTI-CENTER PROSPECTIVE, TEST AND TREAT: STUDY ON HELICOBACTER PYLORI FOR HIGH SCHOOL STUDENTS IN KYOTO PREFECTURE Osamu Handa, Yuji Naito, Atsushi Majima, Rieko Mukai, Yosuke Suyama, Saori Kashiwagi, Takahiro Nakano, Takaaki Murakami, Yuki Toyokawa, Tomohiro Ueda, Katsura Mizushima, Akifumi Fukui, Osamu Dohi, Naohisa Yoshida, Kazuhiro Kamada, Kazuhiro Katada, Kazuhiko Uchiyama, Tomohisa Takagi, Hideyuki Konishi, Yoshito Itoh
st
Background In Japan, a country with high incident of gastric cancer, to reduce the infection rate of Helicobacter pylori (HP) is important to reduce gastric cancer death. It has been reported that the eradication at an early stage of HP infection is effective in preventing HPrelated gastric carcinogenesis in a rat model. Even in human, HP eradication therapy for the younger generation is thought to be much more effective for the primary prevention of gastric carcinogenesis than that for the elder generation. As a part of the gastric cancer elimination project in Kyoto Prefecture, multi-center prospective "test and treat" study on HP for high school students was carried out from April 2015. Aim The aim of this study is to investigate the time trend of HP infection rate in high school student, and to know
nd
Successful eradication of Helicobacter pylori following 1 and 2 -line antibiotic therapy
AGA Abstracts
S-244