Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2024 Nov;12(9):1190-1199.
doi: 10.1002/ueg2.12605. Epub 2024 Aug 1.

Quadruple therapies show a higher eradication rate compared to standard triple therapy for Helicobacter pylori infection within the LEGACy consortium. A multicenter observational study in European and Latin American countries

Patricio Medel-Jara  1   2   3 , Diego Reyes Placencia  4 , Eduardo Fuentes-López  5 , Oscar Corsi  4 , Gonzalo Latorre  4 , Rosario Antón  6   7 , Elena Jiménez  8 , Ana Miralles-Marco  8 , Carmelo Caballero  9 , Hugo Boggino  9 , Daniel Cantero  10 , Rita Barros  11   12 , João Santos-Antunes  11   13   14 , Marc Díez  15   16 , Luis A Quiñones  17   18   19 , Erick Riquelme  20   21 , Antonio Rollán  22 , Leslie C Cerpa  17   19 , Ivania Valdés  23 , Olga P Nyssen  24   25 , Leticia Moreira  26 , Javier P Gisbert  24   25 , M Constanza Camargo  27 , Nayeli Ortiz-Olvera  28 , Alberto M Leon-Takahashi  29 , Erika Ruiz-Garcia  29   30 , Edith A Fernández-Figueroa  31 , Marcelo Garrido  32 , Gareth I Owen  21   33   34   35 , Andrés Cervantes  8   36 , Tania Fleitas  8   36 , Arnoldo Riquelme  4   21
Affiliations
Observational Study

Quadruple therapies show a higher eradication rate compared to standard triple therapy for Helicobacter pylori infection within the LEGACy consortium. A multicenter observational study in European and Latin American countries

Patricio Medel-Jara et al. United European Gastroenterol J. 2024 Nov.

Abstract

Introduction: Gastric cancer (GC) is one of the most lethal malignancies worldwide. Helicobacter pylori is the primary cause of GC; therefore, its eradication reduces the risk of developing this neoplasia. There is extensive evidence regarding quadruple therapy with relevance to the European population. However, in Latin America, data are scarce. Furthermore, there is limited information about the eradication rates achieved by antibiotic schemes in European and Latin American populations.

Objective: To compare the effectiveness of standard triple therapy (STT), quadruple concomitant therapy (QCT), and bismuth quadruple therapy (QBT) in six centers in Europe and Latin America.

Methods: A retrospective study was carried out based on the LEGACy registry from 2017 to 2022. Data from adult patients recruited in Portugal, Spain, Chile, Mexico, and Paraguay with confirmed H. pylori infection who received eradication therapy and confirmatory tests at least 1 month apart were included. Treatment success by each scheme was compared using a mixed multilevel Poisson regression, adjusting for patient sex and age, together with country-specific variables, including prevalence of H. pylori antibiotic resistance (clarithromycin, metronidazole, and amoxicillin), and CYP2C19 polymorphisms.

Results: 772 patients were incorporated (64.64% females; mean age of 52.93 years). The total H. pylori eradication rates were 75.20% (255/339) with STT, 88.70% (159/178) with QCT, and 91.30% (191/209) with QBT. Both quadruple therapies (QCT-QBT) showed significantly higher eradication rates compared with STT, with an adjusted incidence risk ratio (IRR) of 1.25 (p: <0.05); and 1.24 (p: <0.05), respectively. The antibiotic-resistance prevalence by country, but not the prevalence of CYP2C19 polymorphism, showed a statistically significant impact on eradication success.

Conclusions: Both QCT and QBT are superior to STT for H. pylori eradication when adjusted for country-specific antibiotic resistance and CYP2C19 polymorphism in a sample of individuals residing in five countries within two continents.

Keywords: Helicobacter pylori; combination drug therapies; gastric cancer; quadruple therapy; standard triple therapy.

PubMed Disclaimer

Conflict of interest statement

The authors declare that there are no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of the analysis in the LEGACy registry.
See this image and copyright information in PMC

References

    1. Malfertheiner P, Camargo MC, El‐Omar E, Liou J‐M, Peek R, Schulz C, et al. Helicobacter pylori infection. Nat Rev Dis Prim. 2023;9(1):19. 10.1038/s41572-023-00431-8 - DOI - PMC - PubMed
    1. DY G. Helicobacter pylori eradication therapy research: ethical issues and description of results. Clin Gastroenterol Hepatol. 2010;8(12):1032–1036. 10.1016/j.cgh.2010.07.002 - DOI - PubMed
    1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jema A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA cancer J CLIN. 2021;71(3):209–249. 10.3322/caac.21660 - DOI - PubMed
    1. Malfertheiner P, Megraud F, Rokkas T, Gisbert JP, Liou J.‐M, Schulz C, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022;0(9):1–39. 10.1136/gutjnl-2022-327745 - DOI
    1. Rokkas T, Gisbert JP, Malfertheiner P, Niv Y, Gasbarrini A, Leja M, et al. Comparative effectiveness of multiple different first‐line treatment regimens for Helicobacter pylori infection: a network meta‐analysis. Gastroenterology. 2021;161(2):495–507. 10.1053/j.gastro.2021.04.012 - DOI - PubMed

MeSH terms

LinkOut - more resources