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European Registry on Helicobacter pylori management (Hp-EuReg): patterns and trends in first-line empirical eradication prescription and outcomes of 5 years and 21 533 patients

Olga Nyssen 1 Dmitry Bordin 2, 3 Bojan Tepes 4 Ángeles Pérez-Aisa 5 Dino Vaira 6 Maria Caldas 1 Luis Bujanda 7, 8 Manuel Castro-Fernandez 8 Frode Lerang 9 Marcis Leja 10 Luís Rodrigo 11 Theodore Rokkas 12 Limas Kupcinskas 13 Jorge Pérez-Lasala 14 Laimas Jonaitis 13 Oleg Shvets 14 Antonio Gasbarrini 15 Halis Simsek 16 Anthony Axon 17 György Buzás 18 Jose Carlos Machado 19 Yaron Niv 20 Lyudmila Boyanova 21 Adrian Goldis 22 Vincent Lamy 23 Ante Tonkic 24 Krzysztof Przytulski 25 Christoph Beglinger 26 Marino Venerito 27 Peter Bytzer 28 Lisette Capelle 29 Tomica Milosavljević 30 Vladimir Milivojevic 30 Lea Veijola 31 Javier Molina-Infante 32 Liudmila Vologzhanina 33 Galina Fadeenko 34 Ines Ariño 35 Giulia Fiorini 1 Ana Garre 1 Jesús Garrido 36, 37, 1 Cristina F Pérez 38 Ignasi Puig 37 Frederic Heluwaert 39 Francis Megraud 40, 41 Colm O'Morain 42 Javier Gisbert 1, 8, *
* Corresponding author
Abstract : 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.
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https://www.hal.inserm.fr/inserm-02996928
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Submitted on : Monday, November 9, 2020 - 7:09:16 PM
Last modification on : Thursday, December 17, 2020 - 10:02:03 AM

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Olga Nyssen, Dmitry Bordin, Bojan Tepes, Ángeles Pérez-Aisa, Dino Vaira, et al.. European Registry on Helicobacter pylori management (Hp-EuReg): patterns and trends in first-line empirical eradication prescription and outcomes of 5 years and 21 533 patients. Gut, BMJ Publishing Group, 2020, pp.gutjnl-2020-321372. ⟨10.1136/gutjnl-2020-321372⟩. ⟨inserm-02996928⟩

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