TY - JOUR

T1 - European Registry on Helicobacter pylori management (Hp-EuReg)

T2 - Patterns and trends in first-line empirical eradication prescription and outcomes of 5 years and 21 533 patients

AU - Nyssen, Olga P.

AU - Bordin, Dmitry

AU - Tepes, Bojan

AU - Pérez-Aisa, Ángeles

AU - Vaira, Dino

AU - Caldas, Maria

AU - Bujanda, Luis

AU - Castro-Fernandez, Manuel

AU - Lerang, Frode

AU - Leja, Marcis

AU - Rodrigo, Luís

AU - Rokkas, Theodore

AU - Kupcinskas, Limas

AU - Pérez-Lasala, Jorge

AU - Jonaitis, Laimas

AU - Shvets, Oleg

AU - Gasbarrini, Antonio

AU - Simsek, Halis

AU - Axon, Anthony T.R.

AU - Buzás, György

AU - Machado, Jose Carlos

AU - Niv, Yaron

AU - Boyanova, Lyudmila

AU - Goldis, Adrian

AU - Lamy, Vincent

AU - Tonkic, Ante

AU - Przytulski, Krzysztof

AU - Beglinger, Christoph

AU - Venerito, Marino

AU - Bytzer, Peter

AU - Capelle, Lisette

AU - Milosavljević, Tomica

AU - Milivojevic, Vladimir

AU - Veijola, Lea

AU - Molina-Infante, Javier

AU - Vologzhanina, Liudmila

AU - Fadeenko, Galina

AU - Ariño, Ines

AU - Fiorini, Giulia

AU - Garre, Ana

AU - Garrido, Jesús

AU - F Pérez, Cristina

AU - Puig, Ignasi

AU - Heluwaert, Frederic

AU - Megraud, Francis

AU - O'Morain, Colm

AU - Gisbert, Javier P.

PY - 2021

Y1 - 2021

N2 - Objective The best approach for Helicobacter pylori management remains unclear. An audit process is essential to ensure clinical practice is aligned with best standards of care. Design International multicentre prospective non-interventional registry starting in 2013 aimed to evaluate the decisions and outcomes in H. pylori management by European gastroenterologists. Patients were registered in an e-CRF by AEG-REDCap. Variables included demographics, previous eradication attempts, prescribed treatment, adverse events and outcomes. Data monitoring was performed to ensure data quality. Time-trend and geographical analyses were performed. Results 30 394 patients from 27 European countries were evaluated and 21 533 (78%) first-line empirical H. pylori treatments were included for analysis. Pretreatment resistance rates were 23% to clarithromycin, 32% to metronidazole and 13% to both. Triple therapy with amoxicillin and clarithromycin was most commonly prescribed (39%), achieving 81.5% modified intention-to-treat eradication rate. Over 90% eradication was obtained only with 10-day bismuth quadruple or 14-day concomitant treatments. Longer treatment duration, higher acid inhibition and compliance were associated with higher eradication rates. Time-trend analysis showed a region-dependent shift in prescriptions including abandoning triple therapies, using higher acid-inhibition and longer treatments, which was associated with an overall effectiveness increase (84%-90%). Conclusion Management of H. pylori infection by European gastroenterologists is heterogeneous, suboptimal and discrepant with current recommendations. Only quadruple therapies lasting at least 10 days are able to achieve over 90% eradication rates. European recommendations are being slowly and heterogeneously incorporated into routine clinical practice, which was associated with a corresponding increase in effectiveness.

AB - Objective The best approach for Helicobacter pylori management remains unclear. An audit process is essential to ensure clinical practice is aligned with best standards of care. Design International multicentre prospective non-interventional registry starting in 2013 aimed to evaluate the decisions and outcomes in H. pylori management by European gastroenterologists. Patients were registered in an e-CRF by AEG-REDCap. Variables included demographics, previous eradication attempts, prescribed treatment, adverse events and outcomes. Data monitoring was performed to ensure data quality. Time-trend and geographical analyses were performed. Results 30 394 patients from 27 European countries were evaluated and 21 533 (78%) first-line empirical H. pylori treatments were included for analysis. Pretreatment resistance rates were 23% to clarithromycin, 32% to metronidazole and 13% to both. Triple therapy with amoxicillin and clarithromycin was most commonly prescribed (39%), achieving 81.5% modified intention-to-treat eradication rate. Over 90% eradication was obtained only with 10-day bismuth quadruple or 14-day concomitant treatments. Longer treatment duration, higher acid inhibition and compliance were associated with higher eradication rates. Time-trend analysis showed a region-dependent shift in prescriptions including abandoning triple therapies, using higher acid-inhibition and longer treatments, which was associated with an overall effectiveness increase (84%-90%). Conclusion Management of H. pylori infection by European gastroenterologists is heterogeneous, suboptimal and discrepant with current recommendations. Only quadruple therapies lasting at least 10 days are able to achieve over 90% eradication rates. European recommendations are being slowly and heterogeneously incorporated into routine clinical practice, which was associated with a corresponding increase in effectiveness.

KW - helicobacter pylori

KW - helicobacter pylori - treatment

U2 - 10.1136/gutjnl-2020-321372

DO - 10.1136/gutjnl-2020-321372

M3 - Journal article

C2 - 32958544

AN - SCOPUS:85097663529

VL - 70

SP - 40

EP - 54

JO - Gut

JF - Gut

SN - 0017-5749

IS - 1

ER -