# Treatment and Follow-Up of Patients With Helicobacter pylori Infection in Primary Health Care: A Retrospective Multicenter Study

## TL;DR

This study examines how Helicobacter pylori infections are treated in primary care in Portugal, finding that newer treatments are more effective but older ones are still widely used.

## Contribution

The study provides real-world evidence on treatment trends and outcomes for Helicobacter pylori in primary care settings.

## Key findings

- Bismuth quadruple therapy increased from 20% to 71.3% and achieved a 91.8% eradication rate.
- Clarithromycin triple therapy decreased but still accounted for 18.5% of prescriptions with a 72.5% eradication rate.
- Only 1.3% of patients used probiotics and 69.2% had post-treatment testing.

## Abstract

Introduction: Helicobacter pylori (HP) infection is a major public health concern worldwide, which is responsible for significant morbidity and mortality associated with gastric disease. In Portugal, high prevalence and antibiotic resistance complicate eradication efforts. The aim of this study was to evaluate current practices in the management of HP infection in primary health care by assessing treatment prescription patterns, probiotic association, eradication testing, and outcomes.

Methods: We performed a retrospective, multicenter study on 1,478 adult patients diagnosed with HP infection through gastric biopsy, urea breath test, or stool antigen test between April 2019 and April 2024 in five primary health care units in northern Portugal. Data on demographics, antibiotic regimens, probiotic use, eradication testing, and eradication outcomes were extracted from national electronic health databases and analyzed using descriptive and inferential statistics.

Results: A total of 1,478 patients were diagnosed with HP infection (56.2% female; mean age 57.6 years), and 95.1% received treatment. Prescription patterns changed over time, with bismuth quadruple (BQ) therapy increasing from 20% to 71.3%, while clarithromycin triple (CT) therapy decreased from 44.1% to 18.5%. Probiotics were used as adjuvant therapy in only 1.3% of patients. Post-treatment eradication testing was prescribed to 69.2% of treated patients, resulting in an overall eradication rate of 84.5%. BQ therapy achieved the highest success rate at 91.8%, while CT therapy had the lowest at 72.5%.

Conclusion: Primary care physicians in northern Portugal are progressively prescribing guideline-recommended BQ therapy, which demonstrated HP eradication rates above the accepted 90% benchmark. However, CT therapy remains widely used despite high antibiotic resistance and suboptimal eradication rates, and follow-up eradication testing is underutilized, underscoring important gaps in clinical practice. Updating national guidelines, reinforcing antibiotic resistance surveillance, and standardizing follow-up protocols are essential to optimize HP management in primary care.