Helicobacter resistance is increasing | NTVG

Resistance is increasing worldwide, including in the Netherlands. Gastric biopsies are required to determine resistance, but most patients are treated empirically by their GP on the basis of a positive monoclonal faecal test. It now appears that this group is responding increasingly poorly to the treatment (BJGP Open. 2024; online March 4).

Dutch researchers came to this conclusion based on an analysis of the data of 5,224 patients (average age 54 years; 40% male) who received empirical treatment from their GP in the period 2010-2020 for H. pylori. They looked at, among other things, the success of eradication therapy and clinical remission of stomach complaints.

Because test results were not always included in the patient file, patients were treated as H. pylori-considered positive if they received treatment for it. The patients who received a second eradication treatment within 12 months were considered resistant. The NHG standard ‘Stomach complaints’ recommends that, in case of persistent complaints, diagnostics be carried out according to: H. pylori to repeat, but those test results were also not always in the file.

Such a second treatment was necessary in 8% of patients (n = 416). Of these, 72% (n = 299) were treated for 7 days or less. The number of patients who have a second H. pyloritreatment increased by 0.8% per year (95% CI: 0.33-1.22). Three months after successful eradication, 48% of patients used an antacid. After unsuccessful eradication this number was considerably higher (85%). There were no data on patient compliance.

These results are in line with the increase in resistance that has been seen in secondary care for some time, says Mattijs Numans, professor of general medicine at the LUMC and co-author of the article. ‘There is no direct measure for monitoring resistance in general practice. With the indirect measure we used, we see the number of primary care patients who are re-treated increasing each year. We interpret this as resistance. We also saw that a longer first treatment course is associated with a lower chance of recurrence of complaints. It is not yet clear how long treatment needs to be for optimal effect, especially because compliance may decrease with a longer course. Discussions are currently taking place about a possible adjustment to the NHG guideline.’