Smoking increases the likelihood of Helicobacter pylori treatment failure

Background and aims Data regarding the impact of smoking on the success of Helicobacter pylori (H. pylori) eradication are conflicting, partially due to the fact that sociodemographic status is associated with both smoking and H. pylori treatment success. We aimed to assess the effect of smoking on H. pylori eradication rates after controlling for sociodemographic confounders. Methods Included were subjects aged 15 years or older, with a first time positive C¹³-urea breath test (C¹³-UBT) between 2007 to 2014, who underwent a second C¹³-UBT after receiving clarithromycin-based triple therapy. Data regarding age, gender, socioeconomic status (SES), smoking (current smokers or “never smoked”), and drug use were extracted from the Clalit health maintenance organization database. Results Out of 120,914 subjects with a positive first time C¹³-UBT, 50,836 (42.0%) underwent a second C¹³-UBT test. After excluding former smokers, 48,130 remained who were eligible for analysis. The mean age was 44.3 ± 18.2 years, 69.2% were females, 87.8% were Jewish and 12.2% Arabs, 25.5% were current smokers. The overall eradication failure rates were 33.3%: 34.8% in current smokers and 32.8% in subjects who never smoked. In a multivariate analysis, eradication failure was positively associated with current smoking (Odds Ratio {OR} 1.15, 95% CI 1.10–1.20, p < 0.001), female gender (OR 1.20, 95% CI 1.14–1.25, p < 0.001) and a low socioeconomic status (OR 1.24, 95% CI 1.17–1.31, p < 0.001). Conclusions After controlling for socio-demographic confounders, smoking was found to significantly increase the likelihood of unsuccessful first-line treatment for H. pylori infection.