A recent paper from Duke Clinical Research Institute (DCRI) faculty on behalf of the American Gastroenterological Association (AGA) provides new tools for health care providers treating patients with gastric intestinal metaplasia (GIM) and Helicobacter pylori (H. pylori) infections.
H. pylori infections are a common precursor to gastric cancer — the third leading cause of cancer-related deaths worldwide. Once detected, these infections can be treated with antibiotics, but rates of failed H. pylori treatment are on the rise.
H. pylori is highly prevalent with about 50% of people globally estimated to be infected, including roughly 35% of the population in the U.S. Although the prevalence of H. pylori infections across the U.S. has fallen over time, patients from groups that historically have been economically and socially marginalized are disproportionately affected. By offering new quality control measures, the authors of this paper hope to reduce rates of failed H. pylori eradication and reduce patients’ risks of developing gastric cancer.
Faculty from the DCRI, the Yale School of Medicine, the Indiana University School of Medicine, the Georgetown University School of Medicine, and the Inova Health System collaborated to assess AGA recommendations and develop quality measures to help providers make evidence-based recommendations and better understand adherence to those recommendations. They evaluated three of the AGA’s recommendation statements for potential quality measures for health care providers treating GIM patients with an H. pylori infection.
Among the recommendations and suggestions outlined in the AGA guideline, the authors endorsed the recommendation that following the cycle of antibiotics intended to treat the infection, providers must test the patient for H. pylori to confirm it is eradicated. Additionally, the authors worked with AGA to develop a flow chart to assist providers in implementing the quality measure.
“This was the recommendation that had the strongest evidence and strength of recommendation to support it, and we felt that there was a meaningful gap – or enough variation of care around this – that improvement would not only be feasible, but that it would have an impact on outcomes,” said David Leiman, MD, MSHP, an Assistant Professor of Medicine, DCRI faculty member and chair of the AGA Quality Committee.
The paper also assessed the AGA Clinical Practice Guidelines suggesting against routine use of endoscopic surveillance and the routine short-interval repeat endoscopy for patients with GIM. Because of insufficient evidence supporting or opposing these procedures, these recommendations were not considered for quality measure development.
Other authors of the paper include Kenneth Hung, MD, MS; Jennifer Maratt, MD, MS; Won Kyoo Cho, MD; Brijen J. Shah, MD; and Chioma Anjou, MD, MPH.