Nationwide Trends in Helicobacter pylori Eradication Therapies in Korea: Impact of Guideline Updates on Treatment Practices

Abstract

Introduction: Helicobacter pylori infects over 50% of the global population, prompting the issuance of guidelines for effective diagnosis and treatment. However, research on guideline dissemination and adherence is limited. Therefore, we assessed the nationwide status of H. pylori eradication therapies in Korea before and after guideline updates.

Methods: Using data from the Korean National Health Insurance Service, this retrospective cohort study analyzed changes in H. pylori eradication therapies across three periods: Phase I (2006-2007), Phase II (2014-2015), and Phase III (2021-2022). It examined therapy regimens, confirmation tests, and retreatment rates.

Results: Among 1,657,746 patients included, the number undergoing eradication therapy increased across the phases (Phase I: 234,365; Phase II: 493,889; Phase III: 929,492). The use of conventional triple therapy declined from 96.1% in Phase I to 88.3% in Phase III, while non-bismuth and bismuth quadruple therapies increased to 6.8% and 3.3%, respectively, in Phase III. The proportion of patients following a 1-week regimen of conventional triple therapy decreased from 90.3% in Phase I to 54.2% in Phase III, while a 2-week regimen increased to 36.1% in Phase III. Confirmation testing within 1 year of therapy increased from 21.3% in Phase I to 43.0% in Phase III, whereas retreatment rates increased from 3.8% in Phase I to 8.8% in Phase III.

Conclusions: Guideline updates have influenced H. pylori eradication practices in Korea, leading to increased use of quadruple therapies with longer treatment durations. However, further improvements in confirmatory tests and retreatment following failed initial therapy are required.