Effectiveness of Susceptibility-Guided Therapy for Helicobacter pylori Infection: A Retrospective Analysis by Propensity Score Matching

Wenyue Zhou,1 Haoxuan Cheng,1 Miaomiao Li,1 Ruian Zhang,1 Zhiren Li,1 Guangyong Sun,2 Dong Zhang,2 Xinjuan Liu,1 Yanxiang Pei1 1Department of Gastroenterology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Medical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, Chaoyang District, Beijing, 100024, People’s Republic of ChinaCorrespondence: Xinjuan Liu; Yanxiang Pei, Department of Gastroenterology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China, Email liuxinjuan@mail.ccmu.edu.cn; peiyanxiang1972@126.comPurpose: This study evaluates and compares the eradication rates of Helicobacter pylori (H. pylori) achieved through susceptibility-guided therapy (SGT) based on resistance genotyping and empirical therapy (ET).Patients and Methods: A retrospective study was conducted at Beijing Chaoyang Hospital (2021– 2023) on patients with H. pylori infection receiving initial eradication therapy. Resistance genotypes for clarithromycin and levofloxacin were identified using fluorescent PCR of gastric biopsy samples. Patients underwent a 14-day bismuth-containing quadruple therapy (BQT) and were evaluated via the C13 urea breath test (UBT). Based on genotyping or clinical judgment, 550 patients were assigned to SGT (n = 125) or ET (n = 425). The SGT group received personalized treatment based on genotype testing results, avoiding the use of antibiotics to which the bacteria were resistant. The ET group received the standard bismuth-containing quadruple therapy (BQT). Additionally, 29 ET patients underwent follow-up genotypic testing and eradication rates were analyzed retrospectively.Results: SGT achieved higher eradication rates than ET (ITT: 94.4% vs 86.1%, P = 0.012; PP: 95.2% vs 87.6%, P = 0.016). In levofloxacin-resistant strains, SGT showed significantly higher eradication rates in the PP analysis (95.7% vs 50.0%, P = 0.049).Conclusion: SGT exhibited remarkably superior eradication rates, notably in levofloxacin-resistant strains, proposing a compelling alternative for the treatment of H. pylori, particularly in instances of antimicrobial resistance.Keywords: Helicobacter pylori infection, susceptibility-guided therapy, bismuth-containing quadruple regimen, propensity score matching