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Multicenter Study
. 2021 Jan;70(1):40-54.
doi: 10.1136/gutjnl-2020-321372. Epub 2020 Sep 21.

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 P Nyssen  1 , Dmitry Bordin  2   3 , Bojan Tepes  4 , Ángeles Pérez-Aisa  5 , Dino Vaira  6 , Maria Caldas  1 , Luis Bujanda  7 , 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  15 , Antonio Gasbarrini  16 , Halis Simsek  17 , Anthony T R Axon  18 , György Buzás  19 , Jose Carlos Machado  20 , Yaron Niv  21 , Lyudmila Boyanova  22 , Adrian Goldis  23 , Vincent Lamy  24 , Ante Tonkic  25 , Krzysztof Przytulski  26 , Christoph Beglinger  27 , Marino Venerito  28 , Peter Bytzer  29 , Lisette Capelle  30 , Tomica Milosavljević  31 , Vladimir Milivojevic  31 , Lea Veijola  32 , Javier Molina-Infante  33 , Liudmila Vologzhanina  34 , Galina Fadeenko  35 , Ines Ariño  36 , Giulia Fiorini  6 , Ana Garre  1 , Jesús Garrido  37 , Cristina F Pérez  38 , Ignasi Puig  39 , Frederic Heluwaert  40 , Francis Megraud  41 , Colm O'Morain  42 , Javier P Gisbert  43 ; Hp-EuReg Investigators
Collaborators, Affiliations
Free article
Multicenter Study

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 P Nyssen et al. Gut. 2021 Jan.
Free article

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.

Keywords: helicobacter pylori; helicobacter pylori - treatment.

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Conflict of interest statement

Competing interests: JPG has served as speaker, consultant and advisory member for or has received research funding from Mayoly, Allergan and Diasorin. OPN has received a research grant from Allergan. JM-I has served as a consultant for Casen Recordati and has received retribution from Allergan for formative actions. MC-F has received retribution from Allergan for formative actions. PB has served as speaker, consultant and advisory member for or has received research funding from Almirall, Allergan and Reckitt Benckiser. APA has received retribution from Allergan and Mylan for formative actions. DSB has served as lecturer for Astellas, AstraZeneca, KRKA and Abbott.

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