Characteristics of Helicobacter pylori Eradication Therapy in Patients 80 Years or Older Living in a Metropolitan Area: A Multicenter Retrospective Study

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter Pub Date : 2024-08-16 DOI:10.1111/hel.13125

Eri Iwata, Mitsushige Sugimoto, Daisuke Asaoka, Mariko Hojo, Masayoshi Ito, Naoko Kitazawa, Naoto Kurihara, Tatsuhiro Masaoka, Shigeaki Mizuno, Hideki Mori, Akihito Nagahara, Ryota Niikura, Toshifumi Ohkusa, Masaya Sano, Yuji Shimada, Hidekazu Suzuki, Yoshiaki Takeuchi, Akifumi Tanaka, Kengo Tokunaga, Kumiko Ueda, Nobuhiro Sakaki, Shin'ichi Takahashi, Takashi Kawai

{"title":"Characteristics of Helicobacter pylori Eradication Therapy in Patients 80 Years or Older Living in a Metropolitan Area: A Multicenter Retrospective Study","authors":"Eri Iwata, Mitsushige Sugimoto, Daisuke Asaoka, Mariko Hojo, Masayoshi Ito, Naoko Kitazawa, Naoto Kurihara, Tatsuhiro Masaoka, Shigeaki Mizuno, Hideki Mori, Akihito Nagahara, Ryota Niikura, Toshifumi Ohkusa, Masaya Sano, Yuji Shimada, Hidekazu Suzuki, Yoshiaki Takeuchi, Akifumi Tanaka, Kengo Tokunaga, Kumiko Ueda, Nobuhiro Sakaki, Shin'ichi Takahashi, Takashi Kawai","doi":"10.1111/hel.13125","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>The situation of <i>Helicobacter pylori</i> eradication therapy has been changing over time, owing to increases in antimicrobial-resistant strains, lifestyle improvements, and changes in indications for eradication. In Japan, eradication therapy is now available to all <i>H. pylori</i>-positive patients under the medical insurance system, and the potassium-competitive acid blocker vonoprazan has been used for eradication from 2015. Recently, with the aging of society, opportunities to provide eradication to elderly patients are increasing, but the current status and effectiveness of eradication in elderly patients remains unclear. Therefore, we aimed to investigate the trends of <i>H. pylori</i> eradication in a metropolitan area to determine the factors associated with successful <i>H. pylori</i> eradication in elderly patients older than 80 years.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Trends in the eradication rates of patients who received first- or second-line eradication at 20 hospitals in the Tokyo metropolitan area from 2013 to 2023 were investigated.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The eradication rates in the per-protocol analysis were 82.3% (95% confidence interval [CI]: 81.2%–83.2%) for the first-line treatment (<i>n</i> = 6481), and 87.9% (86.9%–88.9%) for the second-line treatment (<i>n</i> = 4899). Multivariate analysis showed that independent factors for successful eradication in the first-line treatment were an age of older than 80 years (OR: 0.606; 95% CI: 0.448–0.822), peptic ulcers (vs. atrophic gastritis: 3.817; 3.286–4.433), and vonoprazan (vs. proton pump inhibiters (PPIs), 3.817; 3.286–4.433), and an age of older than 80 years (0.503; 0.362–0.699) and vonoprazan (1.386; 1.153–1.667) in the second-line treatment.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>After 2015, the eradication rate of both first- and second-line therapies were maintained at a higher level than before 2015, owing to the use of vonoprazan. As the <i>H. pylori</i> eradication rate in patients older than 80 years was low, an effective strategy for these patients needs to be developed in the future.</p>\n </section>\n </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"29 4","pages":""},"PeriodicalIF":4.3000,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hel.13125","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Helicobacter","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/hel.13125","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

The situation of Helicobacter pylori eradication therapy has been changing over time, owing to increases in antimicrobial-resistant strains, lifestyle improvements, and changes in indications for eradication. In Japan, eradication therapy is now available to all H. pylori-positive patients under the medical insurance system, and the potassium-competitive acid blocker vonoprazan has been used for eradication from 2015. Recently, with the aging of society, opportunities to provide eradication to elderly patients are increasing, but the current status and effectiveness of eradication in elderly patients remains unclear. Therefore, we aimed to investigate the trends of H. pylori eradication in a metropolitan area to determine the factors associated with successful H. pylori eradication in elderly patients older than 80 years.

Methods

Trends in the eradication rates of patients who received first- or second-line eradication at 20 hospitals in the Tokyo metropolitan area from 2013 to 2023 were investigated.

Results

The eradication rates in the per-protocol analysis were 82.3% (95% confidence interval [CI]: 81.2%–83.2%) for the first-line treatment (n = 6481), and 87.9% (86.9%–88.9%) for the second-line treatment (n = 4899). Multivariate analysis showed that independent factors for successful eradication in the first-line treatment were an age of older than 80 years (OR: 0.606; 95% CI: 0.448–0.822), peptic ulcers (vs. atrophic gastritis: 3.817; 3.286–4.433), and vonoprazan (vs. proton pump inhibiters (PPIs), 3.817; 3.286–4.433), and an age of older than 80 years (0.503; 0.362–0.699) and vonoprazan (1.386; 1.153–1.667) in the second-line treatment.

Conclusion

After 2015, the eradication rate of both first- and second-line therapies were maintained at a higher level than before 2015, owing to the use of vonoprazan. As the H. pylori eradication rate in patients older than 80 years was low, an effective strategy for these patients needs to be developed in the future.

Abstract Image

查看原文本刊更多论文

生活在大都市地区的 80 岁及以上患者接受幽门螺杆菌根除疗法的特点：一项多中心回顾性研究

背景随着时间的推移，幽门螺杆菌根除疗法的情况也在发生变化，原因包括耐抗菌菌株的增加、生活方式的改善以及根除适应症的改变。在日本，目前所有幽门螺杆菌阳性患者均可享受医疗保险制度下的根除治疗，并且从 2015 年开始使用钾竞争性酸阻断剂 vonoprazan 进行根除治疗。近来，随着社会老龄化的加剧，为老年患者提供根除治疗的机会越来越多，但老年患者的根除治疗现状和效果仍不明确。因此，我们旨在调查大都市地区幽门螺杆菌根除的趋势，以确定 80 岁以上老年患者成功根除幽门螺杆菌的相关因素。方法调查了东京都内 20 家医院在 2013 年至 2023 年期间接受一线或二线根除治疗的患者的根除率趋势。结果在按协议分析中，一线治疗（n = 6481）的根除率为 82.3%（95% 置信区间 [CI]：81.2%-83.2%），二线治疗（n = 4899）的根除率为 87.9%（86.9%-88.9%）。多变量分析显示，一线治疗成功根除的独立因素是年龄大于 80 岁（OR：0.606；95% CI：0.448-0.822）、消化性溃疡（与萎缩性胃炎相比：3.817；3.286-4.433）、沃诺普赞（vs 质子泵抑制剂（PPIs），3.817；3.286-4.433），二线治疗中年龄大于 80 岁（0.503；0.362-0.699）、沃诺普赞（1.386；1.153-1.667）。结论 2015 年后，由于使用了伏诺普拉赞，一线和二线疗法的根除率均保持在比 2015 年前更高的水平。由于 80 岁以上患者的幽门螺杆菌根除率较低，今后需要针对这些患者制定有效的策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Helicobacter 医学-微生物学

CiteScore

8.40

自引率

9.10%

发文量

审稿时长

2 months

期刊介绍： Helicobacter is edited by Professor David Y Graham. The editorial and peer review process is an independent process. Whenever there is a conflict of interest, the editor and editorial board will declare their interests and affiliations. Helicobacter recognises the critical role that has been established for Helicobacter pylori in peptic ulcer, gastric adenocarcinoma, and primary gastric lymphoma. As new helicobacter species are now regularly being discovered, Helicobacter covers the entire range of helicobacter research, increasing communication among the fields of gastroenterology; microbiology; vaccine development; laboratory animal science.