A6 TREATMENT TRIAL RESULTS FROM COMMUNITY H. PYLORI PROJECTS IN ARCTIC CANADA. (15th March 2019)

• Record Type: Journal Article
• Authors: Veldhuyzen van Zanten, S; Morse, A; Morse, J; Girgis, S; Assi, A; Fagan-Garcia, K; Geary, J; Goodman, K
• Is Part Of: Journal of the Canadian Association of Gastroenterology. Volume 2(2019)Supplement 2
• Page Start: 13
• Page End: 14
• Publication Date: 2019-03-15
• Subjects: Gastroenterology -- Periodicals; 616.33005
• DOI: 10.1093/jcag/gwz006.005
• Languages: English
• ISSNs: 2515-2084

Abstract

Abstract: Background: Helicobacter pylori ( Hp ) infection is a health concern in Arctic Canada, where prevalence of Hp and gastric cancer rates are high. The Canadian North Helicobacter pylori (CAN Help ) Working Group conducts community projects to address public concerns, describe the disease burden, and inform regional health policy. Projects were launched projects during 2007–2017 in Aklavik, Tuktoyaktuk, Fort McPherson, and Inuvik in the Northwest Territories and Old Crow, Teslin, Ross River, Carmacks, and Pelly Crossing in Yukon. Aims: To provide summary data on success of anti-Hp therapies in the NWT and Yukon Methods: In each community, a planning committee guided the research design and conduct. Projects included UBT screening, upper GI endoscopy, treatment, and knowledge exchange. All Hp -positive participants ≥15 years old could enroll in a series of randomized treatment trials to one of the following anti- Hp therapies: - CA: 10-day combination of proton pump inhibitor (PPI), clarithromycin and amoxicillin - Sequential therapy (ST) 10 day: PPI and amoxicillin for days 1–5, followed by PPI, clarithromycin and metronidazole for days 6–10 - BMT quadruple (BMT): 10–14 day bismuth quadruple therapy with PPI, bismuth, metronidazole, and tetracycline - CAM 14 day quadruple therapy with PPI, clarithromycin, amoxicillin, and metronidazole - AL: 14 day PPI, amoxicillin and levofloxacin Treatment adjustments: CA therapy was discontinued in 2008 after initial results showed poor effectiveness. Based on ST results and new Canadian guidelines ST was replaced by CAM in 2015 and treatment duration became 14 days.Treatment success is defined as a negative UBT at >=10 weeks post treatment. Results: To date, of 1421 community Hp project participants, 1305 were tested for Hp by UBT (positivity=52%), 398 had endoscopy with gastric biopsy, 268 enrolled in the treatment trial, and 225 had a post-treatment UBT. In 5 patients the UBT was equivocal and these were excluded. Treatment trial results: Of trial participants with a follow-up UBT, the proportion with treatment success was: PPI-CA 62% (29/47; 95%CI 46–75%); ST 72% (70/97; 95%CI 62–81%); BMT 92% (56/61; 95%CI 82–97%) and 100% (15/15; 95%CI 82–100%) of those randomized to CAM. Of 68 participants treated outside the clinical trial with a follow-up UBT, the proportion with treatment success was: PPI-CA 41% (7/17; 95%CI 18–67%); ST 47% (8/17; 95%CI 23–72%); BMT 92% (15/18; 95%CI 59–96%), CAM 67% (2/3; 95%CI 9–99%)and AL 3/3(100%, 95%CI 37–100%), In 10 patients the treatment was unknown. Conclusions: While treatment success estimates from this treatment trial in Canadian Arctic communities are somewhat imprecise, results demonstrate superiority of bismuth based quadruple and non-bismuth quadruple (CAM) therapies to sequential or triple therapy. Compliance with follow up UBT testing is suboptimal. Funding Agencies: CIHRInuvialuit Regional Corporation, Alberta Innovates Health Solutions, ArcticNet