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Luzko I, P Nyssen O, Moreira L, Gisbert JP. Safety profile of Helicobacter pylori eradication treatments: literature review and updated data of the European Registry on Helicobacter pylori management (Hp-EuReg). Expert Opin Drug Saf 2024; 23:553-564. [PMID: 38557327 DOI: 10.1080/14740338.2024.2338245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/28/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Helicobacter pylori (H. pylori), the most prevalent chronic infection globally, is the major cause of relevant diseases such as gastric cancer, leading to high morbidity and mortality worldwide. Several studies have focused on optimize H. pylori eradication treatment through combination therapies and antibiotic resistance. However, the adverse events profile and its impact, as a primary outcome, remains underexplored.The aim of this review was to summarize the available data on the safety of the most common regimens for H. pylori eradication and its impact on the compliance. AREAS COVERED This review encompassed the published evidence from the years 2008 to 2023 regarding both the safety and compliance for most common H. pylori eradication regimens. The main sources for this review comprised MEDLINE, PubMed, and Cochrane electronic databases. Furthermore, it included a safety analysis of unpublished data from the European Registry on H. pylori management (Hp-EuReg). EXPERT OPINION Poor compliance is correlated with significantly lower cure rates, and this is a unique modifiable source of H. pylori treatment failure. Eradication treatments have become complex, involving multiple drugs and dosing intervals. Thus, patient education is crucial; doctors must explain to the patient about potential temporary and most often harmless side effects.
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Affiliation(s)
- Irina Luzko
- Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, Barcelona, Spain
| | - Olga P Nyssen
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Leticia Moreira
- Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, Barcelona, Spain
| | - Javier P Gisbert
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
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Huguet JM, Ferrer-Barceló L, Suárez P, Barcelo-Cerda S, Sempere J, Saracino IM, Fiorini G, Vaira D, Pérez-Aísa Á, Jonaitis L, Tepes B, Castro-Fernandez M, Pabón-Carrasco M, Keco-Huerga A, Voynovan I, Lucendo AJ, Lanas Á, Martínez-Domínguez SJ, Alfaro Almajano E, Rodrigo L, Vologzanina L, Bordin DS, Gasbarrini A, Babayeva G, Lerang F, Leja M, Kupčinskas J, Rokkas T, Marcos-Pinto R, Meštrović A, Gridnyev O, Phull PS, Smith SM, Boltin D, Buzás GM, Kral J, Şimşek H, Matysiak-Budnik T, Milivojevic V, Marlicz W, Venerito M, Boyanova L, Doulberis M, Capelle LG, Cano-Català A, Moreira L, Nyssen OP, Mégraud F, O'Morain C, Gisbert JP. Role of compliance in Helicobacter pylori eradication treatment: Results of the European Registry on H. pylori management. United European Gastroenterol J 2024. [PMID: 38685613 DOI: 10.1002/ueg2.12569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/04/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Adherence to Helicobacter pylori (H. pylori) eradication treatment is a cornerstone for achieving adequate treatment efficacy. OBJECTIVE To determine which factors influence compliance with treatment. METHODS A systematic prospective non-interventional registry (Hp-EuReg) of the clinical practice of European gastroenterologists. Compliance was considered adequate if ≥90% drug intake. Data were collected until September 2021 using the AEG-REDCap e-CRF and were subjected to quality control. Modified intention-to-treat analyses were performed. Multivariate analysis carried out the factors associated with the effectiveness of treatment and compliance. RESULTS Compliance was inadequate in 646 (1.7%) of 38,698 patients. The non-compliance rate was higher in patients prescribed longer regimens (10-, 14-days) and rescue treatments, patients with uninvestigated dyspepsia/functional dyspepsia, and patients reporting adverse effects. Prevalence of non-adherence was lower for first-line treatment than for rescue treatment (1.5% vs. 2.2%; p < 0.001). Differences in non-adherence in the three most frequent first-line treatments were shown: 1.1% with proton pump inhibitor + clarithromycin + amoxicillin; 2.3% with proton pump inhibitor clarithromycin amoxicillin metronidazole; and 1.8% with bismuth quadruple therapy. These treatments were significantly more effective in compliant than in non-compliant patients: 86% versus 44%, 90% versus 71%, and 93% versus 64%, respectively (p < 0.001). In the multivariate analysis, the variable most significantly associated with higher effectiveness was adequate compliance (odds ratio, 6.3 [95%CI, 5.2-7.7]; p < 0.001). CONCLUSIONS Compliance with Helicobacter pylori eradication treatment is very good. Factors associated with poor compliance include uninvestigated/functional dyspepsia, rescue-treatment, prolonged treatment regimens, the presence of adverse events, and the use of non-bismuth sequential and concomitant treatment. Adequate treatment compliance was the variable most closely associated with successful eradication.
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Affiliation(s)
- Jose M Huguet
- Department of Gastroenterology, Hospital General Universitario de Valencia, Valencia, Spain
| | - Luis Ferrer-Barceló
- Department of Gastroenterology, Hospital General Universitario de Valencia, Valencia, Spain
| | - Patrícia Suárez
- Department of Gastroenterology, Hospital General Universitario de Valencia, Valencia, Spain
| | - Susana Barcelo-Cerda
- Department of Applied Statistics and Operational Research, and Quality, Universitat Politècnica de Valencia, Valencia, Spain
| | - Javier Sempere
- Department of Gastroenterology, Hospital General Universitario de Valencia, Valencia, Spain
| | | | - Giulia Fiorini
- IRCCS S. Orsola Polyclinic, University of Bologna, Bologna, Italy
| | - Dino Vaira
- IRCCS S. Orsola Polyclinic, University of Bologna, Bologna, Italy
| | - Ángeles Pérez-Aísa
- Agencia Sanitaria Costa del Sol, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Marbella, Spain
| | - Laimas Jonaitis
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Bojan Tepes
- Department of Gastroenterology, AM DC Rogaska, Rogaska Slatina, Slovenia
| | - M Castro-Fernandez
- Unidad de Aparato Digestivo, Hospital Universitario de Valme, Sevilla, Spain
| | | | - Alma Keco-Huerga
- Unidad de Aparato Digestivo, Hospital Universitario de Valme, Sevilla, Spain
| | - Irina Voynovan
- Department of Gastroenterology, A.S. Loginov Moscow Clinical Scientific Center, Moscow, Russia
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain
- CIBER de enfermedades Hepáticas y Digestiva (CIBERehd), Madrid, Spain
- Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Tomelloso, Spain
| | - Ángel Lanas
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- CIBERehd, Zaragoza, Spain
| | - Samuel J Martínez-Domínguez
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- CIBERehd, Zaragoza, Spain
| | - Enrique Alfaro Almajano
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
- CIBERehd, Zaragoza, Spain
| | - Luis Rodrigo
- Department of Gastroenterology, University of Oviedo, Oviedo, Spain
| | | | - Dmitry S Bordin
- Department of Pancreatic, Biliary and Upper Digestive Tract Disorders, A. S. Loginov Moscow Clinical Scientific Center, Moscow, Russia
- Department of Propaedeutic of Internal Diseases and Gastroenterology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Department of Outpatient Therapy and Family Medicine, Tver State Medical University, Tver, Russia
| | - Antonio Gasbarrini
- Medicina interna e Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Gülüstan Babayeva
- Department of Therapy, Azerbaijan State Advanced Training Institute for Doctors Named After Aziz Aliyev, Baku, Azerbaijan
- Memorial Clinic, Baku, Azerbaijan
| | - Frode Lerang
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway
| | - Mārcis Leja
- Department of Gastroenterology, Digestive Diseases Centre, Riga, Latvia
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
| | - Juozas Kupčinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Theodore Rokkas
- Department of Gastroenterology, Henry Dunant Hospital, Athens, Greece
| | - Ricardo Marcos-Pinto
- Gastroenterology Department, Centro Hospitalar do Porto, Instituto De Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal
- Cintesis, Center for Research in Health Technologies and Information Systems (CINTESIS), Porto, Portugal
| | - Antonio Meštrović
- Department of Gastroenterology, University Hospital of Split, University of Split School of Medicine, Split, Croatia
| | - Oleksiy Gridnyev
- Division for the Study of the Digestive Diseases and its Comorbidity with Noncommunicable Diseases, Government Institution L.T.Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
| | - Perminder S Phull
- Department of Digestive Disorders, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Sinead M Smith
- Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Doron Boltin
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - György Miklós Buzás
- Department of Gastroenterology, Ferencváros Health Centre, Budapest, Hungary
| | - Jan Kral
- Hepatogastroenterology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Halis Şimşek
- Division of Gastroenterology and Hepatology, Hacettepe University School of Medicine, Ankara, Turkey
| | | | - Vladimir Milivojevic
- Department of Gastroenterology, Clinical Center of Serbia, University of Belgrade School of Medicine, Belgrade, Serbia
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University in Szczecin, Szczecin, Poland
- The Centre for Digestive Diseases, Endoklinika, Szczecin, Poland
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - Lyudmila Boyanova
- Department of Gastroenterology, Medical Microbiology, Medical University of Sofia, Sofia, Bulgaria
| | - Michael Doulberis
- Medical University Department, Division of Gastroenterology and Hepatology, Kantonsspital Aarau, Aarau, Switzerland
- Gastroklinik, Private Gastroenterological Practice, Horgen, Switzerland
| | - Lisette G Capelle
- Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, Netherlands
| | - Anna Cano-Català
- GOES Research Group, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Leticia Moreira
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, Barcelona, Spain
| | - Olga P Nyssen
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | | | - Colm O'Morain
- Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Javier P Gisbert
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
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Bujanda L, Nyssen OP, Ramos J, Bordin DS, Tepes B, Perez-Aisa A, Pavoni M, Castro-Fernandez M, Lerang F, Leja M, Rodrigo L, Rokkas T, Kupcinskas J, Jonaitis L, Shvets O, Gasbarrini A, Simsek H, Phull PS, Buzás GM, Machado JC, Boltin D, Boyanova L, Tonkić A, Marlicz W, Venerito M, Vologzanina L, Fadieienko GD, Fiorini G, Resina E, Muñoz R, Cano-Català A, Puig I, García-Morales N, Hernández L, Moreira L, Megraud F, Morain CO, Montes M, Gisbert JP. Effectiveness of Helicobacter pylori Treatments According to Antibiotic Resistance. Am J Gastroenterol 2024; 119:646-654. [PMID: 37983769 DOI: 10.14309/ajg.0000000000002600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/02/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Antibiotic resistance is one of the main factors that determine the efficacy of treatments to eradicate Helicobacter pylori infection. Our aim was to evaluate the effectiveness of first-line and rescue treatments against H. pylori in Europe according to antibiotics resistance. METHODS Prospective, multicenter, international registry on the management of H. pylori (European Registry on H. pylori Management). All infected and culture-diagnosed adult patients registered in the Spanish Association of Gastroenterology-Research Electronic Data Capture from 2013 to 2021 were included. RESULTS A total of 2,852 naive patients with culture results were analyzed. Resistance to clarithromycin, metronidazole, and quinolones was 22%, 27%, and 18%, respectively. The most effective treatment, regardless of resistance, were the 3-in-1 single capsule with bismuth, metronidazole, and tetracycline (91%) and the quadruple with bismuth, offering optimal cure rates even in the presence of bacterial resistance to clarithromycin or metronidazole. The concomitant regimen with tinidazole achieved an eradication rate of 99% (90/91) vs 84% (90/107) with metronidazole. Triple schedules, sequential, or concomitant regimen with metronidazole did not achieve optimal results. A total of 1,118 non-naive patients were analyzed. Resistance to clarithromycin, metronidazole, and quinolones was 49%, 41%, and 24%, respectively. The 3-in-1 single capsule (87%) and the triple therapy with levofloxacin (85%) were the only ones that provided encouraging results. DISCUSSION In regions where the antibiotic resistance rate of H. pylori is high, eradication treatment with the 3-in-1 single capsule, the quadruple with bismuth, and concomitant with tinidazole are the best options in naive patients. In non-naive patients, the 3-in-1 single capsule and the triple therapy with levofloxacin provided encouraging results.
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Affiliation(s)
- Luis Bujanda
- Department of Gastroenterology, Biodonostia Health Research Institute, San Sebastián; CIBERehd, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid; Department of Medicine, Universidad Del País Vasco (UPV/EHU), San Sebastián, Spain
| | - Olga P Nyssen
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - June Ramos
- Department of Gastroenterology, Biodonostia Health Research Institute, San Sebastián; CIBERehd, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid; Department of Medicine, Universidad Del País Vasco (UPV/EHU), San Sebastián, Spain
| | - Dmitry S Bordin
- Department of Pancreatic, Biliary and Upper Digestive Tract Disorders, A. S. Loginov Moscow Clinical Scientific Center, Moscow; Department of Propaedeutic of Internal Diseases and Gastroenterology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow; Department of Outpatient Therapy and Family Medicine, Tver State Medical University, Tver, Russia
| | - Bojan Tepes
- Department of Gastroenterology, DC Rogaska, Slatina, Slovenia
| | | | - Matteo Pavoni
- Department of Medical and Surgical Sciences, IRCCS St. Orsola Polyclinic, University of Bologna, Bologna, Italy
| | | | - Frode Lerang
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway
| | - Mārcis Leja
- Gastro, Digestive Diseases Centre, Riga; Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
| | - Luis Rodrigo
- Gastroenterology, University of Oviedo, Oviedo, Spain
| | - Theodore Rokkas
- Gastroenterology Clinic, Henry Dunant Hospital, Athens, Greece
| | - Juozas Kupcinskas
- Institute for Digestive Research and Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Laimas Jonaitis
- Institute for Digestive Research and Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Oleg Shvets
- Department of Gastroenterology, Internal Medicine, National Medical University, Kyiv, Ukraine
| | - Antonio Gasbarrini
- Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Halis Simsek
- Department of Gastroenterology, Hacettepe University, Ankara; Department of Gastroenterology, HC International Clinic, Ankara, Turkey
| | - Perminder S Phull
- Department of Digestive Disorders, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Jose C Machado
- 3S-Instituto de Investigação e Inovação Em Saúde da Universidade Do Porto, Porto; Ipatimup-Instituto de Patologia e Imunologia Molecular da Universidade Do Porto, Porto; Pathology, FMUP-Faculdade de Medicina Do Porto, Porto, Portugal
| | - Doron Boltin
- Division of Gastroenterology, Rabin Medical Center, PetahTikva; Sackler School of Medicine, Tel Aviv University, TelAviv, Israel
| | - Lyudmila Boyanova
- Department of Medical Microbiology, Medical University of Sofia, Sofia, Bulgaria
| | - Ante Tonkić
- Department of Gastroenterology, University Hospital of Split, Split, Croatia
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University in Szczecin, Szczecin; The Centre for Digestive Diseases, Endoklinika, Szczecin, Poland
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital of Magdeburg, Magdeburg, Germany
| | | | - Galina D Fadieienko
- L.T. Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
| | - Giulia Fiorini
- Department of Medical and Surgical Sciences, IRCCS St. Orsola Polyclinic, University of Bologna, Bologna, Italy
| | - Elena Resina
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Raquel Muñoz
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Anna Cano-Català
- GOES Research Group, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Ignasi Puig
- Althaia Xarxa Assistencial Universitària de Manresa and Universitat de Vic-Universitat Central de Catalunya (UVicUCC), Manresa, Spain
| | - Natalia García-Morales
- Complexo Hospitalario Universitario de Vigo (CHUVI) and Galicia Sur Health Research Institute (IIS Galicia Sur); SERGAS-UVIGO, Spain
| | - Luis Hernández
- Unidad de Gastroenterología, Hospital Santos Reyes, Aranda de Duero, Spain
| | - Leticia Moreira
- Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS (Institut D'Investigacions Biomèdiques August Pi I Sunyer), University of Barcelona, Barcelona, Spain
| | | | | | - Milagrosa Montes
- Department of Microbiology, Donostia University Hospital-Biodonostia Health Research Institute, San Sebastian, Spain
| | - Javier P Gisbert
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
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Moss SF, Shah SC, Tan MC, El-Serag HB. Evolving Concepts in Helicobacter pylori Management. Gastroenterology 2024; 166:267-283. [PMID: 37806461 PMCID: PMC10843279 DOI: 10.1053/j.gastro.2023.09.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/10/2023] [Accepted: 09/18/2023] [Indexed: 10/10/2023]
Abstract
Helicobacter pylori is the most common chronic bacterial infection worldwide and the most significant risk factor for gastric cancer, which remains a leading cause of cancer-related death globally. H pylori and gastric cancer continue to disproportionately impact racial and ethnic minority and immigrant groups in the United States. The approach to H pylori case-finding thus far has relied on opportunistic testing based on symptoms or high-risk indicators, such as racial or ethnic background and family history. However, this approach misses a substantial proportion of individuals infected with H pylori who remain at risk for gastric cancer because most infections remain clinically silent. Moreover, individuals with chronic H pylori infection are at risk for gastric preneoplastic lesions, which are also asymptomatic and only reliably diagnosed using endoscopy and biopsy. Thus, to make a significant impact in gastric cancer prevention, a systematic approach is needed to better identify individuals at highest risk of both H pylori infection and its complications, including gastric preneoplasia and cancer. The approach to H pylori eradication must also be optimized given sharply decreasing rates of successful eradication with commonly used therapies and increasing antimicrobial resistance. With growing acceptance that H pylori should be managed as an infectious disease and the increasing availability of susceptibility testing, we now have the momentum to abandon empirical therapies demonstrated to have inadequate eradication rates. Molecular-based susceptibility profiling facilitates selection of a personalized eradication regimen without necessitating an invasive procedure. An improved approach to H pylori eradication coupled with population-level programs for screening and treatment could be an effective and efficient strategy to prevent gastric cancer, especially in minority and potentially marginalized populations that bear the heaviest burden of H pylori infection and its complications.
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Affiliation(s)
- Steven F Moss
- Brown University, Providence, Rhode Island; Providence VA Medical Center, Providence, Rhode Island
| | - Shailja C Shah
- University of California at San Diego, San Diego, California; VA San Diego Healthcare System, San Diego, California
| | - Mimi C Tan
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Hashem B El-Serag
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
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5
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Pabón-Carrasco M, Keco-Huerga A, Castro-Fernández M, Saracino IM, Fiorini G, Vaira D, Pérez-Aísa Á, Tepes B, Jonaitis L, Voynovan I, Lucendo AJ, Lanas Á, Martínez-Domínguez SJ, Almajano EA, Rodrigo L, Vologzanina L, Brglez Jurecic N, Denkovski M, Bujanda L, Abdulkhakov RA, Huguet JM, Fernández-Salazar L, Alcaide N, Velayos B, Silkanovna Sarsenbaeva A, Zaytsev O, Ilchishina T, Barrio J, Bakulin I, Perona M, Alekseenko S, Romano M, Gravina AG, Núñez Ó, Gómez Rodríguez BJ, Ledro-Cano D, Pellicano R, Bogomolov P, Domínguez-Cajal M, Almela P, Gomez-Camarero J, Bordin DS, Gasbarrini A, Kupčinskas J, Cano-Català A, Moreira L, Nyssen OP, Mégraud F, O'Morain C, Gisbert JP. Role of proton pump inhibitors dosage and duration in Helicobacter pylori eradication treatment: Results from the European Registry on H. pylori management. United European Gastroenterol J 2024; 12:122-138. [PMID: 38050339 PMCID: PMC10859719 DOI: 10.1002/ueg2.12476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/15/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Management of Helicobacter pylori (H. pylori) infection requires co-treatment with proton pump inhibitors (PPIs) and the use of antibiotics to achieve successful eradication. AIM To evaluate the role of dosage of PPIs and the duration of therapy in the effectiveness of H. pylori eradication treatments based on the 'European Registry on Helicobacter pylori management' (Hp-EuReg). METHODS Hp-EuReg is a multicentre, prospective, non-interventionist, international registry on the routine clinical practice of H. pylori management by European gastroenterologists. All infected adult patients were systematically registered from 2013 to 2022. RESULTS Overall, 36,579 patients from five countries with more than 1000 patients were analysed. Optimal (≥90%) first-line-modified intention-to-treat effectiveness was achieved with the following treatments: (1) 14-day therapies with clarithromycin-amoxicillin-bismuth and metronidazole-tetracycline-bismuth, both independently of the PPI dose prescribed; (2) All 10-day (except 10-day standard triple therapy) and 14-day therapies with high-dose PPIs; and (3) 10-day quadruple therapies with clarithromycin-amoxicillin-bismuth, metronidazole-tetracycline-bismuth, and clarithromycin-amoxicillin-metronidazole (sequential), all with standard-dose PPIs. In first-line treatment, optimal effectiveness was obtained with high-dose PPIs in all 14-day treatments, in 10- and 14-day bismuth quadruple therapies and in 10-day sequential with standard-dose PPIs. Optimal second-line effectiveness was achieved with (1) metronidazole-tetracycline-bismuth quadruple therapy for 14- and 10 days with standard and high-dose PPIs, respectively; and (2) levofloxacin-amoxicillin triple therapy for 14 days with high-dose PPIs. None of the 7-day therapies in both treatment lines achieved optimal effectiveness. CONCLUSIONS We recommend, in first-line treatment, the use of high-dose PPIs in 14-day triple therapy and in 10-or 14-day quadruple concomitant therapy in first-line treatment, while standard-dose PPIs would be sufficient in 10-day bismuth quadruple therapies. On the other hand, in second-line treatment, high-dose PPIs would be more beneficial in 14-day triple therapy with levofloxacin and amoxicillin or in 10-day bismuth quadruple therapy either as a three-in-one single capsule or in the traditional scheme.
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Affiliation(s)
| | - Alma Keco-Huerga
- Department of Gastroenterology, Hospital de Valme, Sevilla, Spain
| | | | | | | | | | - Ángeles Pérez-Aísa
- Agencia Sanitaria Costa del Sol, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Marbella, Spain
| | - Bojan Tepes
- Department of Gastroenterology, AM DC Rogaska, Rogaska Slatina, Slovenia
| | - Laimas Jonaitis
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Irina Voynovan
- Department of Gastroenterology, A.S. Loginov Moscow Clinical Scientific Center, Moscow, Russia
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain
| | - Ángel Lanas
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | - Luis Rodrigo
- Gastroenterology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Maja Denkovski
- Department of Gastroenterology, Interni Oddelek, Diagnostic Centre, Bled, Slovenia
| | - Luis Bujanda
- Hospital Donostia, Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | - Rustam A Abdulkhakov
- Department of Hospital Medicine, Kazan State Medical University, Kazan, Tatarstan, Russia
| | - Jose M Huguet
- Patología Digestiva, Hospital General Universitario de Valencia, Valencia, Spain
| | - Luis Fernández-Salazar
- Gastroenterology Department, Hospital Clínico Universitario de Valladolid (SACYL), Valladolid, Spain
| | - Noelia Alcaide
- Gastroenterology Department, Hospital Clínico Universitario de Valladolid (SACYL), Valladolid, Spain
| | - Benito Velayos
- Gastroenterology Department, Hospital Clínico Universitario de Valladolid (SACYL), Valladolid, Spain
| | | | - Oleg Zaytsev
- Gastroenterology Unit, First Clinical Medical Center Kovrov, Kovrov, Russia
| | | | - Jesús Barrio
- Unidad de Gastroenterología, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - Igor Bakulin
- I.I. Mechnikov North-Western State Medical University, Saint Petersburg, Russia
| | - Monica Perona
- Gastroenterology Unit, Hospital Quiron Marbella, Marbella, Spain
| | | | - Marco Romano
- Gastroenterology and Endoscopy Unit, Dipartimento di Medicina di Precisione, Università Vanvitelli, Napoli, Italy
| | - Antonietta G Gravina
- Gastroenterology and Endoscopy Unit, Dipartimento di Medicina di Precisione, Università Vanvitelli, Napoli, Italy
| | - Óscar Núñez
- Gastroenterology Unit, Hospital Universitario La Moraleja, Madrid, Spain
| | | | - Diego Ledro-Cano
- Gastroenterology Department, Hospital Virgen de la Macarena, Sevilla, Spain
| | | | | | - Manuel Domínguez-Cajal
- Unidad de Gastroenterología y Hepatología, Hospital Universitario San Jorge, Huesca, Spain
| | - Pedro Almela
- Servicio de Medicina Digestiva, Hospital General Universitario de Castellón, Castellón, Spain
- Ciencias de la Salud (Medicina), Universidad CEU Cardenal Herrera, Castellón, Spain
| | | | - Dmitry S Bordin
- Department of Pancreatic, Biliary and Upper Digestive Tract Disorders, A. S. Loginov Moscow Clinical Scientific Center, Moscow, Russia
- Department of Propaedeutic of Internal Diseases and Gastroenterology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Department of Outpatient Therapy and Family Medicine, Tver State Medical University, Tver, Russia
| | - Antonio Gasbarrini
- Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Juozas Kupčinskas
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Anna Cano-Català
- GOES Research Group, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Leticia Moreira
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, Barcelona, Spain
| | - Olga P Nyssen
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | | | - Colm O'Morain
- Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Javier P Gisbert
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
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6
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Pérez-Aisa Á, Nyssen OP, Keco-Huerga A, Rodrigo L, Lucendo AJ, Gomez-Rodriguez BJ, Ortuño J, Perona M, Huguet JM, Núñez O, Fernandez-Salazar L, Barrio J, Lanas A, Iyo E, Romero PM, Fernández-Bermejo M, Gomez B, Garre A, Gomez-Camarero J, Lamuela LJ, Campillo A, de la Peña-Negro L, Dominguez Cajal M, Bujanda L, Burgos-Santamaría D, Bermejo F, González-Carrera V, Pajares R, Notari PA, Tejedor-Tejada J, Planella M, Jiménez I, Lázaro YA, Cuadrado-Lavín A, Pérez-Martínez I, Amorena E, Gonzalez-Santiago JM, Angueira T, Flores V, Martínez-Domínguez SJ, Pabón-Carrasco M, Velayos B, Algaba A, Ramírez C, Almajano EA, Castro-Fernandez M, Alcaide N, Sanz Segura P, Cano-Català A, García-Morales N, Moreira L, Mégraud F, O'Morain C, Calvet X, Gisbert JP. Bismuth quadruple three-in-one single capsule three times a day increases effectiveness compared with the usual four times a day schedule: results from the European Registry on Helicobacter pylori Management (Hp-EuReg). Gut 2023; 72:2031-2038. [PMID: 37468228 DOI: 10.1136/gutjnl-2022-329259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 06/30/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND The recommended schedule for single capsule bismuth quadruple therapy (scBQT, Pylera) includes a proton pump inhibitor (PPI) two times a day and three scBQT capsules four times a day. Four times a day treatments are inconvenient and reduce adherence. In contrast, adherence improves with three times a day schedules. In clinical practice, many gastroenterologists use four capsule scBQT three times a day. However, the effectiveness and safety of this latter approach remain uncertain. AIM To assess the effectiveness and safety of scBQT administered three times a day in the patients included in the European Registry on Helicobacter pylori Management (Hp-EuReg). METHODS All Spanish adult patients registered in the Asociación Española de Gastroenterología Research Electronic Data Capture (REDCap) database from June 2013 to March 2021 receiving 10-day scBQT were analysed. Modified intention-to-treat effectiveness, adherence and the safety of scBQT given three times a day were calculated and compared with the four times a day schedule. A multivariate analysis was performed to determine independent factors predicting cure of the infection. RESULTS Of the 3712 cases, 2516 (68%) were four times a day and 1196 (32%) three times a day. Mean age was 51 years, 63% were women and 15% had a peptic ulcer. The three times a day schedule showed significantly better overall cure rates than four times a day (1047/1112, 94%; 95% CI 92.7 to 95.6 vs 2207/2423, 91%; 95% CI 89.9 to 92.2, respectively, p=0.002). Adherence and safety data were similar for both regimens. In the multivariate analysis, three times a day dosage, first-line therapy, use of standard or high-dose PPIs and adherence over 90% were significantly associated with cure of the infection. CONCLUSIONS ScBQT prescribed three times a day was more effective than the traditional four times a day schedule. No differences were observed in treatment adherence or safety.
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Affiliation(s)
- Ángeles Pérez-Aisa
- Department of Gastroenterology, Hospital Costal del Sol, Marbella, Spain
- Redes de Investigación Cooperativa orientada a Resultados en Salud (RICORS), Marbella, Spain
| | - Olga P Nyssen
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Alma Keco-Huerga
- Department of Gastroenterology, Hospital de Valme, Sevilla, Spain
| | - Luís Rodrigo
- Gastroenterology Service, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Alfredo J Lucendo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
- Department of Gastroenterology, Hospital General Tomelloso, Tomelloso, Spain
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Madrid, Spain
- Instituto de Investigación Sanitaria Princesa (IIS-Princesa), UniversidadAutónoma de Madrid (UAM), Madrid, Spain
| | | | - Juan Ortuño
- Department of Gastroenterology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Mónica Perona
- Department of Gastroenterology, Hospital Quiron Marbella, Marbella, Spain
| | - José María Huguet
- Gastroenterology Unit, Consorci Hospital General Universitari de Valencia, Valencia, Spain
| | - Oscar Núñez
- Department of Digestive Diseases, Hospital Universitario Sanitas La Moraleja, Madrid, Spain
| | - Luis Fernandez-Salazar
- Gastroenterologia, Hospital Clínico Universitario Valladolid, Gerencia Regional de Salud (SACYL), Valladolid, Spain
- Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - Jesus Barrio
- Department of Gastroenterology, Hospital Rio Hortega, Valladolid, Spain
| | - Angel Lanas
- Instituto de Investigación Sanitària de Aragón (IIS Aragorn), Zaragoza, Spain
- Facultad de Medicina. Universidad de Zaragoza, Zaragoza, Spain
- Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Eduardo Iyo
- Digestive Service, Hospital Comarcal de Inca, Inca, Mallorca, Spain
| | - Pilar Mata Romero
- Department of Gastroenterology, Hospital Universitario de Caceres, Cáceres, Spain
| | | | - Barbara Gomez
- Department of Gastroenterology, Hospital de Mataró, Mataro, Spain
| | - Ana Garre
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | | | - Luis Javier Lamuela
- Instituto de Investigación Sanitària de Aragón (IIS Aragorn), Zaragoza, Spain
- Department of Gastroenterology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Ana Campillo
- Department of Gastroenterology, Hospital Reina Sofía, Tudela, Spain
| | | | | | - Luis Bujanda
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
- Department of Gastroenterology, Hospital Donostia, Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), San Sebastian, Spain
| | - Diego Burgos-Santamaría
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Fernando Bermejo
- Department of Gastroenterology, Hospital Universitario de Fuenlabrada, Madrid, Spain
- Instituto de Investigación Sanitaria La Paz, Madrid, Spain
| | | | - Ramón Pajares
- Department of Gastroenterology, Hospital Universitario Infanta Sofía, San Sebastian de los Reyes, Madrid, Spain
- Medicine Department, Universidad Europea de Madrid SLU, Madrid, Spain
| | - Pedro Almela Notari
- Digestive Service, Hospital General Universitari de Castelló, Castellon de la Plana, Spain
| | | | - Montserrat Planella
- Department of Gastroenterology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Itxaso Jiménez
- Department of Gastroenterology, Hospital Universitario de Galdakao-Usansolo, Galdakao, Spain
| | | | | | - Isabel Pérez-Martínez
- Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Edurne Amorena
- Department of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Jesús M Gonzalez-Santiago
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
- Department of Gastroenterology, Complejo Universitario de Salamanca. IBSAL, Salamanca, Spain
| | - Teresa Angueira
- Department of Gastroenterology, Hospital General Tomelloso, Tomelloso, Spain
| | - Virginia Flores
- Department of Gastroenterology, Hospital General Universitario Gregorio Marañón - Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Samuel J Martínez-Domínguez
- Instituto de Investigación Sanitària de Aragón (IIS Aragorn), Zaragoza, Spain
- Facultad de Medicina. Universidad de Zaragoza, Zaragoza, Spain
- Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Benito Velayos
- Gastroenterologia, Hospital Clínico Universitario Valladolid, Gerencia Regional de Salud (SACYL), Valladolid, Spain
- Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - Alicia Algaba
- Department of Gastroenterology, Hospital Universitario de Fuenlabrada, Madrid, Spain
- Instituto de Investigación Sanitaria La Paz, Madrid, Spain
| | - Consuelo Ramírez
- Department of Gastroenterology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Enrique Alfaro Almajano
- Instituto de Investigación Sanitària de Aragón (IIS Aragorn), Zaragoza, Spain
- Facultad de Medicina. Universidad de Zaragoza, Zaragoza, Spain
- Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Noelia Alcaide
- Gastroenterologia, Hospital Clínico Universitario Valladolid, Gerencia Regional de Salud (SACYL), Valladolid, Spain
- Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | | | - Anna Cano-Català
- Department of Gastroenterology, Research and Innovation Unit, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Natalia García-Morales
- Digestive Service, Complexo Hospitalario Universitario de Vigo Sergas, Vigo, Spain
- South Galicia Health Research Institute, Vigo, Spain
| | - Leticia Moreira
- Department of Gastroenterology, Hospital Clínic-UB, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | | | - Colm O'Morain
- Department of Gastroenterology, Faculty of Health Science, Trinity College Dublin, Dublin, Ireland
| | - Xavier Calvet
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
- Digestive Diseases Department, Parc Taulí, Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí, Departament de Medicina, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Javier P Gisbert
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
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7
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Jonaitis P, Nyssen OP, Saracino IM, Fiorini G, Vaira D, Pérez-Aísa Á, Tepes B, Castro-Fernandez M, Pabón-Carrasco M, Keco-Huerga A, Voynovan I, Lucendo AJ, Lanas Á, Martínez-Domínguez SJ, Almajano EA, Rodrigo L, Vologzanina L, Brglez Jurecic N, Denkovski M, Bujanda L, Mahmudov U, Leja M, Lerang F, Babayeva G, Bordin DS, Gasbarrini A, Kupcinskas J, Gridnyev O, Rokkas T, Marcos-Pinto R, Phull PS, Smith SM, Tonkić A, Boltin D, Buzás GM, Šembera Š, Şimşek H, Matysiak-Budnik T, Milivojevic V, Marlicz W, Venerito M, Boyanova L, Doulberis M, Capelle LG, Cano-Català A, Moreira L, Mégraud F, O'Morain C, Gisbert JP, Jonaitis L. Comparison of the management of Helicobacter pylori infection between the older and younger European populations. Sci Rep 2023; 13:17235. [PMID: 37821503 PMCID: PMC10567783 DOI: 10.1038/s41598-023-43287-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023] Open
Abstract
The prevalence of Helicobacter pylori remains high in the older population. Specific age-related peculiarities may impact the outcomes of H. pylori treatment. The aim of the study was to evaluate the diagnostics and effectiveness of H. pylori eradication between the younger and older European populations. "European Registry on H. pylori Management (Hp-EuReg)" data from 2013 to 2022 were analyzed. Patients were divided into older (≥ 60 years) and younger (18-59 years) groups. Modified intention-to-treat (mITT) and per-protocol (PP) analysis was performed. 49,461 patients included of which 14,467 (29%) were older-aged. Concomitant medications and penicillin allergy were more frequent among the older patients. Differences between younger and older populations were observed in treatment duration in first-line treatment and in proton pump inhibitors (PPIs) doses in second-line treatment. The overall incidence of adverse events was lower in the older adults group. The overall first-line treatment mITT effectiveness was 88% in younger and 90% in the older patients (p < 0.05). The overall second-line mITT treatment effectiveness was 84% in both groups. The effectiveness of the most frequent first- and second-line triple therapies was suboptimal (< 90%) in both groups. Optimal efficacy (≥ 90%) was achieved by using bismuth and non-bismuth-based quadruple therapies. In conclusion, the approach to the diagnostics and treatment of H. pylori infection did not generally differ between younger and older patients. Main differences were reported in the concurrent medications, allergy to penicillin and adverse events both in first- and second-line treatment. Optimal effectiveness rates were mostly achieved by using bismuth and non-bismuth-based quadruple therapies. No clinically relevant differences in the effectiveness between the age groups were observed.
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Affiliation(s)
- Paulius Jonaitis
- Department of Gastroenterology, Lithuanian University of Health Sciences, 50161, Kaunas, Lithuania
| | - Olga P Nyssen
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad Autónoma de Madrid (UAM), Diego de León, 62, 28006, Madrid, Spain.
| | - Ilaria Maria Saracino
- Department of Surgical and Medical Sciences, IRCCS AOUBO, University of Bologna, 40138, Bologna, Italy
| | - Giulia Fiorini
- Department of Surgical and Medical Sciences, IRCCS AOUBO, University of Bologna, 40138, Bologna, Italy
| | - Dino Vaira
- Department of Surgical and Medical Sciences, IRCCS AOUBO, University of Bologna, 40138, Bologna, Italy
| | - Ángeles Pérez-Aísa
- Agencia Sanitaria Costa del Sol, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 29651, Marbella, Spain
| | - Bojan Tepes
- Department of Gastroenterology, AM DC Rogaska, 3250, Rogaska Slatina, Slovenia
| | | | | | - Alma Keco-Huerga
- Department of Gastroenterology, Hospital de Valme, 41014, Seville, Spain
| | - Irina Voynovan
- Department of Gastroenterology, A.S. Loginov Moscow Clinical Scientific Center, 111123, Moscow, Russia
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, 13700, Tomelloso, Spain
| | - Ángel Lanas
- IIS Aragón y Facultad de Medicina de la Universidad de Zaragoza, 50009, Zaragoza, Spain
| | | | | | - Luis Rodrigo
- Gastroenterology Unit, Hospital Universitario Central de Asturias, 33011, Oviedo, Spain
| | | | - Natasa Brglez Jurecic
- Department of Gastroenterology, Interni Oddelek, Diagnostic Centre, 4260, Bled, Slovenia
| | - Maja Denkovski
- Department of Gastroenterology, Interni Oddelek, Diagnostic Centre, 4260, Bled, Slovenia
| | - Luis Bujanda
- Hospital Donostia, Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), 20018, San Sebastián, Spain
| | | | - Mārcis Leja
- Department of Gastroenterology, Digestive Diseases Centre Gastro, Institute of Clinical and Preventive Medicine and Faculty of Medicine, University of Latvia, Riga, 1079, Latvia
| | - Frode Lerang
- Department of Gastroenterology, Østfold Hospital Trust, 1714, Grålum, Norway
| | | | - Dmitry S Bordin
- Department of Gastroenterology, A.S. Loginov Moscow Clinical Scientific Center, 111123, Moscow, Russia
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, 127473, Moscow, Russia
- Tver State Medical University, 170100, Tver, Russia
| | - Antonio Gasbarrini
- Medicina Interna, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Juozas Kupcinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, 50161, Kaunas, Lithuania
| | - Oleksiy Gridnyev
- Government Institution "L.T.Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine", Kyiv, Ukraine
| | - Theodore Rokkas
- Department of Gastroenterology, Henry Dunant Hospital, 115 26, Athens, Greece
| | - Ricardo Marcos-Pinto
- Department of Gastroenterology, Centro Hospitalar do Porto Institute of Biomedical Sciences Abel Salazar, Centro de Investigação em Tecnologias e Serviços de Saúde, University of Porto, 4050-313, Porto, Portugal
| | - Perminder S Phull
- Department of Gastroenterology, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, UK
| | - Sinead M Smith
- Faculty of Health Sciences, Trinity College Dublin, Dublin, D02PN40, Ireland
| | - Ante Tonkić
- Department of Gastroenterology, University Hospital of Split, University of Split School of Medicine, 21000, Split, Croatia
| | - Doron Boltin
- Division of Gastroenterology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, 49100, Tel Aviv, Israel
| | - György Miklós Buzás
- Department of Gastroenterology, Ferencváros Health Centre, 1095, Budapest, Hungary
| | - Štěpán Šembera
- 2nd Department of Internal Medicine and Gastroenterology, University Hospital and Charles University, Faculty of Medicine in Hradec Králové, 500 03, Hradec Králové, Czech Republic
| | - Halis Şimşek
- Division of Gastroenterology and Hepatology, Hacettepe University School of Medicine, 06230, Ankara, Turkey
| | - Tamara Matysiak-Budnik
- Department of Gastroenterology, CHRU de Nantes, Hôpital Hôtel Dieu, 44000, Nantes, France
| | - Vladimir Milivojevic
- Department of Gastroenterology, Clinical Center of Serbia, University of Belgrade School of Medicine, 11000, Belgrade, Serbia
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, 70-204, Szczecin, Poland
| | - Marino Venerito
- Department of Gastroenterology, Otto-Von-Guericke University, 39120, Magdeburg, Germany
| | - Lyudmila Boyanova
- Department of Gastroenterology, Medical Microbiology, Medical University of Sofia, 1431, Sofia, Bulgaria
| | - Michael Doulberis
- Division of Gastroenterology and Hepatology, Medical University Department, Kantonsspital Aarau, 5001, Aarau, Switzerland
| | - Lisette G Capelle
- Department of Gastroenterology, Meander Medical Center, 3813 TZ, Amersfoort, The Netherlands
| | - Anna Cano-Català
- GOES Research Group, Althaia Xarxa Assistencial Universitària de Manresa, 08243, Manresa, Spain
| | - Leticia Moreira
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, 08036, Barcelona, Spain
| | - Francis Mégraud
- INSERM U1312, Université de Bordeaux, 33000, Bordeaux, France
| | - Colm O'Morain
- Faculty of Health Sciences, Trinity College Dublin, Dublin, D02PN40, Ireland
| | - Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad Autónoma de Madrid (UAM), Diego de León, 62, 28006, Madrid, Spain
| | - Laimas Jonaitis
- Department of Gastroenterology, Lithuanian University of Health Sciences, 50161, Kaunas, Lithuania
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Nyssen OP, Pratesi P, Spínola MA, Jonaitis L, Pérez-Aísa Á, Vaira D, Saracino IM, Pavoni M, Fiorini G, Tepes B, Bordin DS, Voynovan I, Lanas Á, Martínez-Domínguez SJ, Alfaro E, Bujanda L, Pabón-Carrasco M, Hernández L, Gasbarrini A, Kupcinskas J, Lerang F, Smith SM, Gridnyev O, Leja M, Rokkas T, Marcos-Pinto R, Meštrović A, Marlicz W, Milivojevic V, Simsek H, Kunovsky L, Papp V, Phull PS, Venerito M, Boyanova L, Boltin D, Niv Y, Matysiak-Budnik T, Doulberis M, Dobru D, Lamy V, Capelle LG, Nikolovska Trpchevska E, Moreira L, Cano-Català A, Parra P, Mégraud F, O’Morain C, Ortega GJ, Gisbert JP. Analysis of Clinical Phenotypes through Machine Learning of First-Line H. pylori Treatment in Europe during the Period 2013-2022: Data from the European Registry on H. pylori Management (Hp-EuReg). Antibiotics (Basel) 2023; 12:1427. [PMID: 37760723 PMCID: PMC10525558 DOI: 10.3390/antibiotics12091427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
The segmentation of patients into homogeneous groups could help to improve eradication therapy effectiveness. Our aim was to determine the most important treatment strategies used in Europe, to evaluate first-line treatment effectiveness according to year and country. Data collection: All first-line empirical treatments registered at AEGREDCap in the European Registry on Helicobacter pylori management (Hp-EuReg) from June 2013 to November 2022. A Boruta method determined the "most important" variables related to treatment effectiveness. Data clustering was performed through multi-correspondence analysis of the resulting six most important variables for every year in the 2013-2022 period. Based on 35,852 patients, the average overall treatment effectiveness increased from 87% in 2013 to 93% in 2022. The lowest effectiveness (80%) was obtained in 2016 in cluster #3 encompassing Slovenia, Lithuania, Latvia, and Russia, treated with 7-day triple therapy with amoxicillin-clarithromycin (92% of cases). The highest effectiveness (95%) was achieved in 2022, mostly in Spain (81%), with the bismuth-quadruple therapy, including the single-capsule (64%) and the concomitant treatment with clarithromycin-amoxicillin-metronidazole/tinidazole (34%) with 10 (69%) and 14 (32%) days. Cluster analysis allowed for the identification of patients in homogeneous treatment groups assessing the effectiveness of different first-line treatments depending on therapy scheme, adherence, country, and prescription year.
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Affiliation(s)
- Olga P. Nyssen
- Digestive System Service of the Hospital Universitario de La Princesa, 28006 Madrid, Spain; (O.P.N.); (P.P.); (J.P.G.)
- Instituto de Investigación Sanitaria Princesa (IIS-Princesa), 28006 Madrid, Spain
- Departamento de Medicina, Universidad Autónoma de Madrid (UAM), 28049 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain; (Á.L.); (S.J.M.-D.); (L.B.); (L.M.)
| | - Pietro Pratesi
- Dipartimento di Statistica e Metodi Quantitativi (DISMEQ), Universitá degli studi di Milano–Bicocca, 20126 Milano, Italy;
| | - Miguel A. Spínola
- Unidad de Análisis de Datos del Instituto de Investigación Sanitaria Princesa (IIS-Princesa), 28006 Madrid, Spain;
| | - Laimas Jonaitis
- Institute for Digestive Research, Department of Gastroenterology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (L.J.); (J.K.)
| | | | - Dino Vaira
- Department of Surgical and Medical Sciences, Sant’Orsola-Malpighi University Hospital, 40138 Bologna, Italy; (D.V.); (I.M.S.); (M.P.); (G.F.)
- Cardiovascular Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Ilaria Maria Saracino
- Department of Surgical and Medical Sciences, Sant’Orsola-Malpighi University Hospital, 40138 Bologna, Italy; (D.V.); (I.M.S.); (M.P.); (G.F.)
| | - Matteo Pavoni
- Department of Surgical and Medical Sciences, Sant’Orsola-Malpighi University Hospital, 40138 Bologna, Italy; (D.V.); (I.M.S.); (M.P.); (G.F.)
| | - Giulia Fiorini
- Department of Surgical and Medical Sciences, Sant’Orsola-Malpighi University Hospital, 40138 Bologna, Italy; (D.V.); (I.M.S.); (M.P.); (G.F.)
| | - Bojan Tepes
- Department of Gastroenterology, DC Rogaska, 3250 Rogaska Slatina, Slovenia;
| | - Dmitry S. Bordin
- Department of Pancreatic, Biliary and Upper Digestive Tract Disorders, A. S. Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia; (D.S.B.); (I.V.)
- Department of Outpatient Therapy and Family Medicine, Tver State Medical University, 170100 Tver, Russia
- Department of Propaedeutic of Internal Diseases and Gastroenterology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, 127473 Moscow, Russia
| | - Irina Voynovan
- Department of Pancreatic, Biliary and Upper Digestive Tract Disorders, A. S. Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia; (D.S.B.); (I.V.)
| | - Ángel Lanas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain; (Á.L.); (S.J.M.-D.); (L.B.); (L.M.)
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain;
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain
| | - Samuel J. Martínez-Domínguez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain; (Á.L.); (S.J.M.-D.); (L.B.); (L.M.)
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain;
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain
| | - Enrique Alfaro
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain;
| | - Luis Bujanda
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain; (Á.L.); (S.J.M.-D.); (L.B.); (L.M.)
- Department of Gastroenterology, Biodonostia Health Research Institute, 20014 San Sebastián, Spain
- Department of Medicine, Universidad del País Vasco (UPV/EHU), 20014 San Sebastián, Spain
| | - Manuel Pabón-Carrasco
- Department of Gastroenterology, Hospital Universitario de Valme, 41014 Seville, Spain;
| | - Luis Hernández
- Gastroenterology Unit, Hospital Santos Reyes, 09400 Aranda de Duero, Spain;
| | - Antonio Gasbarrini
- Medicina interna e Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Juozas Kupcinskas
- Institute for Digestive Research, Department of Gastroenterology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (L.J.); (J.K.)
| | - Frode Lerang
- Department of Gastroenterology, Østfold Hospital Trust, 1714 Grålum, Norway;
| | - Sinead M. Smith
- School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland; (S.M.S.); (C.O.)
| | - Oleksiy Gridnyev
- Departments the Division for the Study of the Digestive Diseases and Its Comorbidity with Noncommunicable Diseases, Government Institution L.T. Malaya Therapy National Institute of NAMS of Ukraine, 61039 Kharkiv, Ukraine;
| | - Mārcis Leja
- Department of Gastroenterology, Digestive Diseases Centre, LV-1006 Riga, Latvia;
- Institute of Clinical and Preventive Medicine, LV-1079 Riga, Latvia
- Faculty of Medicine, University of Latvia, LV-1004 Riga, Latvia
| | - Theodore Rokkas
- Gastroenterology Clinic, Henry Dunant Hospital, 115 26 Athens, Greece;
| | - Ricardo Marcos-Pinto
- Gastroenterology Department, Centro Hospitalar do Porto, 4150-001 Porto, Portugal;
- Instituto De Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, 4050-313, Porto, Portugal
- Center for Research in Health Technologies and Information Systems (CINTESIS), 4200-450 Porto, Portugal
| | - Antonio Meštrović
- Department of Gastroenterology, University Hospital of Split, 21000 Split, Croatia;
- School of Medicine, University of Split, 21000 Split, Croatia
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Vladimir Milivojevic
- Department of Gastroenterology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Halis Simsek
- Department of Gastroenterology, HC International Clinic, Hacettepe University, 06690 Ankara, Turkey;
| | - Lumir Kunovsky
- Department of Internal Medicine—Gastroenterology and Geriatrics, University Hospital Olomouc, 779 00 Olomouc, Czech Republic;
- Faculty of Medicine and Dentistry, Palacky University Olomouc, 779 00 Olomouc, Czech Republic
- Department of Surgery, University Hospital Brno, 625 00 Brno, Czech Republic
- Faculty of Medicine, Masaryk University, 601 77 Brno, Czech Republic
- Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic
| | - Veronika Papp
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1085 Budapest, Hungary;
| | - Perminder S. Phull
- Department of Digestive Disorders, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK;
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital of Magdeburg, 39120 Magdeburg, Germany;
| | - Lyudmila Boyanova
- Department of Medical Microbiology, Medical University of Sofia, 1431 Sofia, Bulgaria;
| | - Doron Boltin
- Division of Gastroenterology, Rabin Medical Center, Tel Aviv University, Tel Aviv-Yafo 49100, Israel;
| | - Yaron Niv
- Adelson Faculty of Medicine, Ariel University, Ariel 4070000, Israel;
| | - Tamara Matysiak-Budnik
- Hepato-Gastroenterology & Digestive Oncology Unit, University Hospital of Nantes, 44000 Nantes, France;
| | - Michael Doulberis
- Gastroenterology Department, Kantonsspital Aarau, 5001 Aarau, Switzerland;
| | - Daniela Dobru
- Department of Gastroenterology, University of Medicine, Pharmacy, Science, and Technology of Târgu Mures, 540142 Târgu Mures, Romania;
| | - Vincent Lamy
- Department of Gastroenterology & Hepatology, CHU de Charleroi, 6042 Charleroi, Belgium;
| | - Lisette G. Capelle
- Department of Gastroenterology and Hepatology, Meander Medical Center, 3813 Amersfoort, The Netherlands;
| | - Emilija Nikolovska Trpchevska
- Department of Gastroenterology, University Clinic for Gastroenterohepatology, 1000 Skopje, North Macedonia;
- Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 1000 Skopje, North Macedonia
| | - Leticia Moreira
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain; (Á.L.); (S.J.M.-D.); (L.B.); (L.M.)
- Hospital Clínic de Barcelona, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Anna Cano-Català
- Gastrointestinal Oncology, Endoscopy and Surgery (GOES) Research Group, Althaia Xarxa Assistencial Universitària de Manresa, 08243 Barcelona, Spain;
- Institut de Recerca i Innovació en Ciències de la Vida i de la Salut de la Catalunya Central (IRIS-CC), 08500 Barcelona, Spain
| | - Pablo Parra
- Digestive System Service of the Hospital Universitario de La Princesa, 28006 Madrid, Spain; (O.P.N.); (P.P.); (J.P.G.)
- Instituto de Investigación Sanitaria Princesa (IIS-Princesa), 28006 Madrid, Spain
- Departamento de Medicina, Universidad Autónoma de Madrid (UAM), 28049 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain; (Á.L.); (S.J.M.-D.); (L.B.); (L.M.)
| | - Francis Mégraud
- INSERM, Institut National de la Santé Et de la Recherche Médicale U1312, Université de Bordeaux, 33077 Bordeaux, France;
| | - Colm O’Morain
- School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland; (S.M.S.); (C.O.)
| | - Guillermo J. Ortega
- Unidad de Análisis de Datos del Instituto de Investigación Sanitaria Princesa (IIS-Princesa), 28006 Madrid, Spain;
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires C1425FQB, Argentina
- Science and Technology and Department, Universidad Nacional de Quilmes, Bernal B1876, Argentina
| | - Javier P. Gisbert
- Digestive System Service of the Hospital Universitario de La Princesa, 28006 Madrid, Spain; (O.P.N.); (P.P.); (J.P.G.)
- Instituto de Investigación Sanitaria Princesa (IIS-Princesa), 28006 Madrid, Spain
- Departamento de Medicina, Universidad Autónoma de Madrid (UAM), 28049 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain; (Á.L.); (S.J.M.-D.); (L.B.); (L.M.)
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Rokkas T, Ekmektzoglou K. Advances in the pharmacological and regulatory management of multidrug resistant Helicobacter pylori. Expert Rev Clin Pharmacol 2023; 16:1229-1237. [PMID: 37937850 DOI: 10.1080/17512433.2023.2282061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/07/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Antibiotic resistance of Helicobacter pylori (H. pylori) hampers the success of eradication and in recent years multidrug resistance (MDR) shows an increase worldwide. AREAS COVERED This review covers current aspects of pharmacological and regulatory management of MDR-resistant H. pylori infection. EXPERT OPINION MDR H. pylori is increasing worldwide and its prevalence varies both between continents and countries. High consumption and misuse of antibiotics, H. pylori treatment failures and bacterial factors such as mutations, efflux pumps and biofilms are among the factors associated with MDR. Important steps for confronting the rise of MDR H. pylori strains should follow the principles of antibiotic stewardship, i.e. eradication regimens should be optimized with regard to all aspects of therapy, including drugs, doses, formulation, frequency of administration, administration in relation to meals and duration of therapy that reliably achieve at least 90% (preferably >95%) cure rates in adherent patients with susceptible infections.
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Affiliation(s)
- Theodore Rokkas
- Gastroenterology Clinic, Henry Dunant Hospital, Athens, Greece
- Medical School, European University of Cyprus, Nicosia, Cyprus
| | - Konstantinos Ekmektzoglou
- Gastroenterology Clinic, Henry Dunant Hospital, Athens, Greece
- Medical School, European University of Cyprus, Nicosia, Cyprus
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García-Morales N, Pérez-Aísa Á, Fiorini G, Tepes B, Castro-Fernández M, Lucendo A, Voynovan I, Bujanda L, Garre A, Rodrigo L, Martínez Domínguez SJ, Denkovski M, Huguet Malavés JM, Jonaitis L, Bumane R, Zaytsev O, Mata Romero P, Barrio J, Fernández-Salazar L, Sarsenbaeva AS, Ortiz Polo I, Alekseenko S, Saracino IM, Vaira D, Keco-Huerga A, Bordin D, Gasbarrini A, Lerang F, Rokkas T, Kupčinskas J, Leja M, Babayeva G, Marcos Pinto R, Tonkić A, Smith S, Phull P, Buzas GM, Simsek H, Boltin D, Gridnyev O, Venerito M, Milivojevic V, Torà N, Cano-Català A, Moreira L, Nyssen OP, Mégraud F, O'Morain C, Gisbert JP, Puig I. Helicobacter pylori Diagnostic Tests Used in Europe: Results of over 34,000 Patients from the European Registry on Helicobacter pylori Management. J Clin Med 2023; 12:4363. [PMID: 37445399 DOI: 10.3390/jcm12134363] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND AND AIMS Several methods are available to diagnose Helicobacter pylori infection. Our objective was to evaluate the tests used for both the initial diagnosis and the confirmation of eradication after treatment in Europe. METHODS The European Registry on the management of Helicobacter pylori infection is an international, multicentre, prospective, non-interventional registry aiming to evaluate the management of Helicobacter pylori-infected patients in Europe. Countries with at least 100 cases registered from June 2013 to April 2021, and with a validated diagnostic method were analysed. Data were quality reviewed. RESULTS A total of 34,920 adult patients from 20 countries were included (mean age 51 years; 61% women). To establish the initial diagnosis, invasive tests were performed in 19,801 (71%) patients, non-invasive in 11,369 (41%), and both in 3437 (12%). The most frequent were histology (n = 11,885; 43%), a rapid urease test (n = 10,636; 38%) and an urea breath test (n = 7577; 27%). According to the age, invasive tests were indicated in 11,179 (77%) ≥50 years, and in 8603 (65%) <50 years. Depending on the country, the use of invasive tests ranged from 29-99% in <50 years to 60-99% in ≥50. Most of the tests used to confirm eradication were non-invasive (n = 32,540; 93%), with the urea breath test being the most frequent (n = 32,540; 78%). In 2983 (9%) post-treatment tests, histology (n = 1887; 5%) or a rapid urease test (n = 1223; 4%) were performed. CONCLUSION A great heterogeneity was observed for the initial diagnosis and confirmation of the eradication. The reasons for the apparent lack of adherence to the clinical guidelines should be further explored.
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Affiliation(s)
- Natalia García-Morales
- Digestive Service, Complexo Hospitalario Universitario de Vigo, Sergas, South Galicia Health Research Institute, 36312 Vigo, Spain
| | - Ángeles Pérez-Aísa
- Unidad de Digestivo, Hospital Costa del Sol Marbella, Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), 29603 Marbella, Spain
| | - Giulia Fiorini
- Department of Surgical and Medical Sciences, IRCCS AOU S. Orsola, 39015 Bologna, Italy
| | - Bojan Tepes
- AM DC Rogaska, 3250 Rogaska Slatina, Slovenia
| | | | | | - Irina Voynovan
- A.S. Loginov, Clinical Scientific Centre, 111123 Moscow, Russia
| | - Luis Bujanda
- Department of Gastroenterology, Biodonostia Health Research Institute, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), 20014 San Sebastián, Spain
| | - Ana Garre
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain
| | - Luis Rodrigo
- Hospital Central de Asturias, 33011 Oviedo, Spain
| | - Samuel Jesús Martínez Domínguez
- Hospital Clínico Lozano Blesa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 50009 Zaragoza, Spain
| | | | | | - Laimas Jonaitis
- Department of Gastroenterology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Renate Bumane
- Digestive Diseases Centre GASTRO, LV-1006 Riga, Latvia
| | - Oleg Zaytsev
- First Clinical Medical Centre, 601900 Kovrov, Russia
| | | | | | | | | | | | | | - Ilaria Maria Saracino
- Department of Surgical and Medical Sciences, IRCCS AOU S. Orsola, 39015 Bologna, Italy
| | - Dino Vaira
- Department of Surgical and Medical Sciences, IRCCS AOU S. Orsola, 39015 Bologna, Italy
| | | | - Dmitry Bordin
- Gastroenterology Unit, A.S. Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia
- Gastroenterology Unit, Department of Outpatient Therapy and Family Medicine, Tver State Medical University, 170100 Tver, Russia
- Gastroenterology Unit, Department of Propaedeutic of Internal and Gastroenterology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, 127473 Moscow, Russia
| | - Antonio Gasbarrini
- Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Frode Lerang
- Central Hospital of Ostfold, 1601 Fredrikstad, Norway
| | | | - Juozas Kupčinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Marcis Leja
- Digestive Diseases Centre GASTRO, LV-1006 Riga, Latvia
| | | | | | - Ante Tonkić
- Department Gastroenterol & Hepatol, University Hospital Centre Split, 2100 Split, Croatia
| | | | | | - Gyorgy M Buzas
- Gastroenterology, Ferencváros Health Centre, Mester utca 45, 1095 Budapest, Hungary
| | - Halis Simsek
- Internal Med Gastroenterol Department, Hacettepe University School of Medicine, 06230 Ankara, Turkey
| | - Doron Boltin
- Division of Gastroenterology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 4941492, Israel
| | - Oleksiy Gridnyev
- L.T. Malaya Therapy National Institute of the National Academy of Medical Sciences, ID 70483 Kharkiv, Ukraine
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, 44, 39120 Magdeburg, Germany
| | | | - Núria Torà
- GOES Research Group, Unitat de Recerca i Innovació, Athaia Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain
| | - Anna Cano-Català
- GOES Research Group, Unitat de Recerca i Innovació, Athaia Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain
| | - Leticia Moreira
- Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERed), 08036 Barcelona, Spain
| | - Olga P Nyssen
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain
| | - Francis Mégraud
- INSERM U1312, Université de Bordeaux, 33000 Bordeaux, France
| | - Colm O'Morain
- Rabin Medical Center, Beilinson Campus, Petah Tikva 49100, Israel
| | - Javier P Gisbert
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain
| | - Ignasi Puig
- Althaia Xarxa Assistencial Universitària de Manresa and Universitat de Vic-Universitat Central de Catalunya (UVicUCC), 08242 Manresa, Spain
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García-Morales N, Pérez-Aísa Á, Fiorini G, Tepes B, Castro-Fernández M, Lucendo A, Voynovan I, Bujanda L, Garre A, Rodrigo L, Martínez Domínguez SJ, Denkovski M, Huguet Malavés JM, Jonaitis L, Bumane R, Zaytsev O, Mata Romero P, Barrio J, Fernández-Salazar L, Sarsenbaeva AS, Ortiz Polo I, Alekseenko S, Saracino IM, Vaira D, Keco-Huerga A, Bordin D, Gasbarrini A, Lerang F, Rokkas T, Kupčinskas J, Leja M, Babayeva G, Marcos Pinto R, Tonkić A, Smith S, Phull P, Buzas GM, Simsek H, Boltin D, Gridnyev O, Venerito M, Milivojevic V, Torà N, Cano-Català A, Moreira L, Nyssen OP, Mégraud F, O’Morain C, Gisbert JP, Puig I. Helicobacter pylori Diagnostic Tests Used in Europe: Results of over 34,000 Patients from the European Registry on Helicobacter pylori Management. J Clin Med 2023; 12:4363. [DOI: https:/doi.org/10.3390/jcm12134363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Background and aims: Several methods are available to diagnose Helicobacter pylori infection. Our objective was to evaluate the tests used for both the initial diagnosis and the confirmation of eradication after treatment in Europe. Methods: The European Registry on the management of Helicobacter pylori infection is an international, multicentre, prospective, non-interventional registry aiming to evaluate the management of Helicobacter pylori-infected patients in Europe. Countries with at least 100 cases registered from June 2013 to April 2021, and with a validated diagnostic method were analysed. Data were quality reviewed. Results: A total of 34,920 adult patients from 20 countries were included (mean age 51 years; 61% women). To establish the initial diagnosis, invasive tests were performed in 19,801 (71%) patients, non-invasive in 11,369 (41%), and both in 3437 (12%). The most frequent were histology (n = 11,885; 43%), a rapid urease test (n = 10,636; 38%) and an urea breath test (n = 7577; 27%). According to the age, invasive tests were indicated in 11,179 (77%) ≥50 years, and in 8603 (65%) <50 years. Depending on the country, the use of invasive tests ranged from 29–99% in <50 years to 60–99% in ≥50. Most of the tests used to confirm eradication were non-invasive (n = 32,540; 93%), with the urea breath test being the most frequent (n = 32,540; 78%). In 2983 (9%) post-treatment tests, histology (n = 1887; 5%) or a rapid urease test (n = 1223; 4%) were performed. Conclusion: A great heterogeneity was observed for the initial diagnosis and confirmation of the eradication. The reasons for the apparent lack of adherence to the clinical guidelines should be further explored.
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Affiliation(s)
- Natalia García-Morales
- Digestive Service, Complexo Hospitalario Universitario de Vigo, Sergas, South Galicia Health Research Institute, 36312 Vigo, Spain
| | - Ángeles Pérez-Aísa
- Unidad de Digestivo, Hospital Costa del Sol Marbella, Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), 29603 Marbella, Spain
| | - Giulia Fiorini
- Department of Surgical and Medical Sciences, IRCCS AOU S. Orsola, 39015 Bologna, Italy
| | - Bojan Tepes
- AM DC Rogaska, 3250 Rogaska Slatina, Slovenia
| | | | | | - Irina Voynovan
- A.S. Loginov, Clinical Scientific Centre, 111123 Moscow, Russia
| | - Luis Bujanda
- Department of Gastroenterology, Biodonostia Health Research Institute, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), 20014 San Sebastián, Spain
| | - Ana Garre
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain
| | - Luis Rodrigo
- Hospital Central de Asturias, 33011 Oviedo, Spain
| | - Samuel Jesús Martínez Domínguez
- Hospital Clínico Lozano Blesa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 50009 Zaragoza, Spain
| | | | | | - Laimas Jonaitis
- Department of Gastroenterology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Renate Bumane
- Digestive Diseases Centre GASTRO, LV-1006 Riga, Latvia
| | - Oleg Zaytsev
- First Clinical Medical Centre, 601900 Kovrov, Russia
| | | | | | | | | | | | | | - Ilaria Maria Saracino
- Department of Surgical and Medical Sciences, IRCCS AOU S. Orsola, 39015 Bologna, Italy
| | - Dino Vaira
- Department of Surgical and Medical Sciences, IRCCS AOU S. Orsola, 39015 Bologna, Italy
| | | | - Dmitry Bordin
- Gastroenterology Unit, A.S. Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia
- Gastroenterology Unit, Department of Outpatient Therapy and Family Medicine, Tver State Medical University, 170100 Tver, Russia
- Gastroenterology Unit, Department of Propaedeutic of Internal and Gastroenterology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, 127473 Moscow, Russia
| | - Antonio Gasbarrini
- Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Frode Lerang
- Central Hospital of Ostfold, 1601 Fredrikstad, Norway
| | | | - Juozas Kupčinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Marcis Leja
- Digestive Diseases Centre GASTRO, LV-1006 Riga, Latvia
| | | | | | - Ante Tonkić
- Department Gastroenterol & Hepatol, University Hospital Centre Split, 2100 Split, Croatia
| | | | | | - Gyorgy M. Buzas
- Gastroenterology, Ferencváros Health Centre, Mester utca 45, 1095 Budapest, Hungary
| | - Halis Simsek
- Internal Med Gastroenterol Department, Hacettepe University School of Medicine, 06230 Ankara, Turkey
| | - Doron Boltin
- Division of Gastroenterology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 4941492, Israel
| | - Oleksiy Gridnyev
- L.T. Malaya Therapy National Institute of the National Academy of Medical Sciences, ID 70483 Kharkiv, Ukraine
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, 44, 39120 Magdeburg, Germany
| | | | - Núria Torà
- GOES Research Group, Unitat de Recerca i Innovació, Athaia Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain
| | - Anna Cano-Català
- GOES Research Group, Unitat de Recerca i Innovació, Athaia Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain
| | - Leticia Moreira
- Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERed), 08036 Barcelona, Spain
| | - Olga P. Nyssen
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain
| | - Francis Mégraud
- INSERM U1312, Université de Bordeaux, 33000 Bordeaux, France
| | - Colm O’Morain
- Rabin Medical Center, Beilinson Campus, Petah Tikva 49100, Israel
| | - Javier P. Gisbert
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain
| | - Ignasi Puig
- Althaia Xarxa Assistencial Universitària de Manresa and Universitat de Vic-Universitat Central de Catalunya (UVicUCC), 08242 Manresa, Spain
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12
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Bordin DS, Voynovan IN, Sarsenbaeva AS, Zaytsev OV, Abdulkhakov RA, Bakulina NV, Bakulin IG, Osipenko MF, Livzan MA, Alekseenko SA, Tarasova LV, Tarasova GN, Bogomolov PO, Maev IV, Andreev DN, Abdulkhakov SR, Starostin BD, Bakanova NV, Kononova AG, Kolbasnikov SV, Bueverova EL, Moreira L, Megraud F, O'Morain C, Perez Nyssen O, Gisbert J. [Effectiveness of empirical Helicobacter pylori eradication therapy with furazolidone in Russia: results from the European Registry on Helicobacter pylori Management (Hp-EuReg)]. TERAPEVT ARKH 2023; 95:120-129. [PMID: 37167127 DOI: 10.26442/00403660.2023.02.202107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND First-line therapy does not always provide a high level of Helicobacter pylori eradication due to the increase of H. pylori resistance to antibiotics; therefore, it remains necessary to identify the most effective rescue treatments. The purpose of this study was to evaluate the efficacy and safety of empirical H. pylori furazolidone-containing regimens. MATERIALS AND METHODS Adult H. pylori infected patients empirically treated with furazolidone-containing eradication regimens were registered in an international, prospective, multicenter non-intervention European registry on H. pylori management (Hp-EuReg). Data were collected at AEG-REDCap e-CRF from 2013 to 2021 and the quality was reviewed. Modified intention-to-treat (mITT) effectiveness analyses were performed. RESULTS Overall 106 patients received empirical furazolidone-containing therapy in Russia. Furazolidone was prescribed in a sequential scheme along with amoxicillin, clarithromycin and a proton pump inhibitor in 68 (64%) cases, triple regimens were prescribed in 28 (26%) patients and quadruple regimens in 10 (9.4%). Treatment duration of 7 days was assigned to 2 (1.9%) patients, 10-day eradication therapy in case of 80 (75%) and 14 days - in 24 (23%) patients. Furazolidone was mainly used in first- (79%) and second-line (21%) regimens. The methods used to diagnose H. pylori infection were: histology (81%), stool antigen test (64%), 13C-urea breath test (6.6%), and rapid urease test (1.9%). The mITT effectiveness of sequential therapy was 100%; 93% with the triple therapy and 75.5% with quadruple therapy. Compliance was reported in 98% of cases. Adverse events were revealed in 5.7% of patients, mostly nausea (3.8%). No serious adverse events were reported. CONCLUSION Furazolidone containing eradication regimens appear to be an effective and safe empirical therapy in Russia.
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Affiliation(s)
- D S Bordin
- Loginov Moscow Clinical Scientific Center
- Yevdokimov Moscow State University of Medicine and Dentistry
- Tver State Medical University
| | | | | | | | | | - N V Bakulina
- Mechnikov North-Western State Medical University
| | - I G Bakulin
- Mechnikov North-Western State Medical University
| | | | | | | | | | | | - P O Bogomolov
- Yevdokimov Moscow State University of Medicine and Dentistry
- Private Medical Center "Universal"
- Vladimirsky Moscow Regional Clinical Research Institute
| | - I V Maev
- Yevdokimov Moscow State University of Medicine and Dentistry
| | - D N Andreev
- Yevdokimov Moscow State University of Medicine and Dentistry
| | | | | | | | | | | | - E L Bueverova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - L Moreira
- Hospital Clínic de Barcelona
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd)
- University of Barcelona
| | | | | | - O Perez Nyssen
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
- Universidad Autónoma de Madrid (UAM)
| | - J Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
- Universidad Autónoma de Madrid (UAM)
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13
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Gatta L, Nyssen OP, Fiorini G, Saracino IM, Pavoni M, Romano M, Gravina AG, Granata L, Pellicano R, Gasbarrini A, Di Leo A, Losurdo G, Franceschi F, Nardone G, Rocco A, Dore MP, Farinati F, Ghisa M, Bellini M, Holton J, Puig I, Vaira D, Borghi C, Mégraud F, O'Morain C, Gisbert JP. Effectiveness of first and second-line empirical treatment in Italy: Results of the European registry on Helicobacter pylori management. United European Gastroenterol J 2022; 11:103-113. [PMID: 36565017 PMCID: PMC9892436 DOI: 10.1002/ueg2.12348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/13/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND AIMS The optimal management of naïve and not naïve Helicobacter pylori patients remains unclear. Therefore, it is essential to evaluate whether the actual clinical practice mirrors the indications suggested by the guidelines. This study aimed to assess the effectiveness and the safety of the empirical first- and second-line treatments prescribed to patients enroled at Italian centres participating in the European Registry on H. pylori Management (Hp-EuReg). METHODS The Hp-EuReg is an international multicentre prospective non-interventional registry starting in 2013 aiming to evaluate the management of H. pylori infection by European gastroenterologists. Patients were registered in an e-CRF by AEG-REDCap. Variables assessed included demographics, previous eradication attempts, treatment regimen, effectiveness, and tolerance. RESULTS Overall, 3723 patients from 2013 to February 2021 were included: 2996 and 727 received an empirical first- and second-line treatment, respectively. According to the modified ITT analysis, among the first-line regimens, only the bismuth quadruple therapy with three-in-one-single capsule (BQT-TSC), the concomitant, and the sequential treatment - all lasting 10 days - achieved an eradication rate >90%. Among the second-line regimens, only the 10-day BQT-TSC reported an effectiveness >90%. High-dose PPI twice daily also significantly increased the effectiveness of some therapies. The BQT-TSC was the regimen with the highest incidence of adverse events. CONCLUSIONS Only quadruple therapies lasting at least 10 days achieved over 90% eradication rates among the empirical first- and second-line regimens. It remains unclear whether high-dose PPI twice daily can improve the efficacy of quadruple treatment.
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Affiliation(s)
- Luigi Gatta
- Gastroenterology UnitVersilia HospitalLido di CamaioreItaly
| | - Olga P. Nyssen
- Hospital Universitario de La PrincesaInstituto de Investigación Sanitaria Princesa (IIS‐Princesa)Universidad Autónoma de Madrid (UAM)and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)MadridSpain
| | - Giulia Fiorini
- Department of Medical and Surgical SciencesIRCCS S. OrsolaUniversity of BolognaBolognaItaly
| | - Ilaria Maria Saracino
- Department of Medical and Surgical SciencesIRCCS S. OrsolaUniversity of BolognaBolognaItaly
| | - Matteo Pavoni
- Department of Medical and Surgical SciencesIRCCS S. OrsolaUniversity of BolognaBolognaItaly
| | - Marco Romano
- Università degli Studi della Campania “Luigi Vanvitelli”NaplesItaly
| | | | - Lucia Granata
- Università degli Studi della Campania “Luigi Vanvitelli”NaplesItaly
| | | | - Antonio Gasbarrini
- Medicina Interna, Fondazione Policlinico Universitario A. Gemelli IRCCSUniversità Cattolica del Sacro CuoreRomeItaly
| | - Alfredo Di Leo
- Section of GastroenterologyDepartment of Emergency and Organ TransplantationUniversity “Aldo Moro” of BariBariItaly
| | - Giuseppe Losurdo
- Section of GastroenterologyDepartment of Emergency and Organ TransplantationUniversity “Aldo Moro” of BariBariItaly
| | - Francesco Franceschi
- Emergency MedicineFondazione Policlinico Universitario “A. Gemelli” IRCCSUniversità Cattolica del Sacro CuoreRomeItaly
| | - Gerardo Nardone
- Gastroenterology UnitDepartment of Clinical Medicine and SurgeryUniversity Federico II of NaplesNaplesItaly
| | - Alba Rocco
- Gastroenterology UnitDepartment of Clinical Medicine and SurgeryUniversity Federico II of NaplesNaplesItaly
| | - Maria Pina Dore
- Department of Medical, Surgical and Experimental ScienceUniversity of SassariSassariItaly
| | - Fabio Farinati
- Gastroenterology UnitDepartment of Surgery, Oncology and GastroenterologyUniversity Hospital of PaduaPaduaItaly
| | - Matteo Ghisa
- Gastroenterology UnitDepartment of Surgery, Oncology and GastroenterologyUniversity Hospital of PaduaPaduaItaly
| | - Massimo Bellini
- Gastrointestinal UnitDepartment of Translational Sciences and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
| | - John Holton
- Department Natural Sciences (Microbiology) University of MiddlesexLondon UK & Dartford & Gravesham NHS TrustDarent Valley HospitalDartfordKentUK
| | - Ignasi Puig
- Althaia Xarxa Assistencial Universitària de Manresa and Universitat de Vic‐Universitat Central de Catalunya (UVicUCC)ManresaSpain
| | - Dino Vaira
- Department of Medical and Surgical SciencesIRCCS S. OrsolaUniversity of BolognaBolognaItaly
| | - Claudio Borghi
- Department of Medical and Surgical SciencesIRCCS S. OrsolaUniversity of BolognaBolognaItaly
| | | | | | - Javier P. Gisbert
- Hospital Universitario de La PrincesaInstituto de Investigación Sanitaria Princesa (IIS‐Princesa)Universidad Autónoma de Madrid (UAM)and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)MadridSpain
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14
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Burgos-Santamaría D, Nyssen OP, Gasbarrini A, Vaira D, Pérez-Aisa Á, Rodrigo L, Pellicano R, Keco-Huerga A, Pabón-Carrasco M, Castro-Fernandez M, Boltin D, Barrio J, Phull P, Kupcinskas J, Jonaitis L, Ortiz-Polo I, Tepes B, Lucendo AJ, Huguet JM, Areia M, Jurecic NB, Denkovski M, Bujanda L, Ramos-San Román J, Cuadrado-Lavín A, Gomez-Camarero J, Jiménez Moreno MA, Lanas A, Martinez-Dominguez SJ, Alfaro E, Marcos-Pinto R, Milivojevic V, Rokkas T, Leja M, Smith S, Tonkić A, Buzás GM, Doulberis M, Venerito M, Lerang F, Bordin DS, Lamy V, Capelle LG, Marlicz W, Dobru D, Gridnyev O, Puig I, Mégraud F, O'Morain C, Gisbert JP. Empirical rescue treatment of Helicobacter pylori infection in third and subsequent lines: 8-year experience in 2144 patients from the European Registry on H. pylori management (Hp-EuReg). Gut 2022; 72:gutjnl-2022-328232. [PMID: 36591610 DOI: 10.1136/gutjnl-2022-328232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/06/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate the use, effectiveness and safety of Helicobacter pylori empirical rescue therapy in third and subsequent treatment lines in Europe. DESIGN International, prospective, non-interventional registry of the clinical practice of European gastroenterologists. Data were collected and quality reviewed until October 2021 at Asociación Española de Gastroenterología-Research Electronic Data Capture. All cases with three or more empirical eradication attempts were assessed for effectiveness by modified intention-to-treat and per-protocol analysis. RESULTS Overall, 2144 treatments were included: 1519, 439, 145 and 41 cases from third, fourth, fifth and sixth treatment lines, respectively. Sixty different therapies were used; the 15 most frequently prescribed encompassed >90% of cases. Overall effectiveness remained <90% in all therapies. Optimised treatments achieved a higher eradication rate than non-optimised (78% vs 67%, p<0.0001). From 2017 to 2021, only 44% of treatments other than 10-day single-capsule therapy used high proton-pump inhibitor doses and lasted ≥14 days. Quadruple therapy containing metronidazole, tetracycline and bismuth achieved optimal eradication rates only when prescribed as third-line treatment, either as 10-day single-capsule therapy (87%) or as 14-day traditional therapy with tetracycline hydrochloride (95%). Triple amoxicillin-levofloxacin therapy achieved 90% effectiveness in Eastern Europe only or when optimised. The overall incidence of adverse events was 31%. CONCLUSION Empirical rescue treatment in third and subsequent lines achieved suboptimal effectiveness in most European regions. Only quadruple bismuth-metronidazole-tetracycline (10-day single-capsule or 14-day traditional scheme) and triple amoxicillin-levofloxacin therapies reached acceptable outcomes in some settings. Compliance with empirical therapy optimisation principles is still poor 5 years after clinical practice guidelines update. TRIAL REGISTRATION NUMBER NCT02328131.
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Affiliation(s)
- Diego Burgos-Santamaría
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Enfermedades Hepáticas y Digestivas, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Olga P Nyssen
- Gastroenterology Unit, Hospital Universitario de la Princesa, Madrid, Spain
- Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
- Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Antonio Gasbarrini
- Internal Medicine, Gastroenterology and Liver Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Italy
| | - Dino Vaira
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Ángeles Pérez-Aisa
- Department of Gastroenterology, Hospital Costa del Sol Marbella, Marbella, Spain
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Marbella, Spain
| | - Luís Rodrigo
- Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Rinaldo Pellicano
- Outpatient Clinic, Molinette-SGAS Hospital, University of Turin, Turin, Italy
| | | | | | - Manuel Castro-Fernandez
- Hospital Universitario Virgen de Valme, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Sevilla, Spain
| | - Doron Boltin
- Department of Gastroenterology, Rabin Medical Center, Beilinson Campus, Tel Aviv University, Petach Tikva, Israel
| | - Jesus Barrio
- Department of Gastroenterology, Hospital Rio Hortega, Valladolid, Spain
| | | | - Juozas Kupcinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Laimas Jonaitis
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Inmaculada Ortiz-Polo
- Department of Gastroenterology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Bojan Tepes
- Department of Gastroenterology, AM DC Rogaska, Rogaska Slatina, Slovenia
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain
| | - José María Huguet
- Gastroenterology Unit, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Miguel Areia
- Francisco Gentil Portuguese Institute for Oncology of Coimbra, Coimbra, Portugal
| | | | | | - Luís Bujanda
- Department of Gastroenterology, Hospital Universitario de Donostia, San Sebastian, Spain
- Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), San Sebastián, Spain
| | - June Ramos-San Román
- Department of Gastroenterology, Hospital Universitario de Donostia, San Sebastian, Spain
| | - Antonio Cuadrado-Lavín
- Department of Gastroenterology and Hepatology, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | | | | | - Angel Lanas
- Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Enrique Alfaro
- Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Ricardo Marcos-Pinto
- Department of Gastroenterology, Centro Hospitalar do Porto, Porto, Portugal
- CINTESIS, University of Porto Institute of Biomedical Sciences Abel Salazar, Porto, Portugal
| | - Vladimir Milivojevic
- University Clinical Center of Serbia Clinic for Gastroenterology and Hepatology, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Theodore Rokkas
- Department of Gastroenterology, Henry Dunant Hospital Center, Athens, Greece
| | - Marcis Leja
- Digestive Disease Center GASTRO, Institute of Clinical and Preventive Medicine, Riga, Latvia
- University of Latvia Faculty of Medicine, Riga, Latvia
| | - Sinead Smith
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Ante Tonkić
- Department of Gastroenterology, University Hospital Center Split Križine, Split, Croatia
| | - György Miklós Buzás
- Department of Gastroenterology, Ferencváros Health Centre, Budapest, Hungary
| | - Michael Doulberis
- Division of Gastroenterology and Hepatology, Kantonsspital Aarau AG, Aarau, Switzerland
- Department of Gastroenterology and Hepatology, University of Zurich, Zurich, Switzerland
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
| | - Frode Lerang
- Department of Gastroenterololgy, Ostfold Hospital, Gralum, Norway
| | - Dmitry S Bordin
- Department of Pancreatic, Biliary and Upper Digestive Tract disorders, AS Loginov Moscow Clinical Scientific Center, Moscow, Russian Federation
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
| | | | - Lisette G Capelle
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Daniela Dobru
- Department of Gastroenterology, University of Medicine, Pharmacy, Science, and Technology of Târgu Mures, Târgu Mures, Romania
| | | | - Ignasi Puig
- Department of Digestive Diseases, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain
- Universitat de Vic-Universitat Central de Catalunya (UVicUCC), Manresa, Spain
| | | | - Colm O'Morain
- Department of Gastroenterology, Trinity College Dublin, Dublin, Ireland
| | - Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de la Princesa, Madrid, Spain
- Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
- Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
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Nyssen OP, Vaira D, Pérez Aísa Á, Rodrigo L, Castro-Fernandez M, Jonaitis L, Tepes B, Vologzhanina L, Caldas M, Lanas A, Lucendo AJ, Bujanda L, Ortuño J, Barrio J, Huguet JM, Voynovan I, Lasala JP, Sarsenbaeva AS, Fernandez-Salazar L, Molina-Infante J, Jurecic NB, Areia M, Gasbarrini A, Kupčinskas J, Bordin D, Marcos-Pinto R, Lerang F, Leja M, Buzas GM, Niv Y, Rokkas T, Phull P, Smith S, Shvets O, Venerito M, Milivojevic V, Simsek I, Lamy V, Bytzer P, Boyanova L, Kunovský L, Beglinger C, Doulberis M, Marlicz W, Goldis A, Tonkić A, Capelle L, Puig I, Megraud F, Morain CO, Gisbert JP. Empirical Second-Line Therapy in 5000 Patients of the European Registry on Helicobacter pylori Management (Hp-EuReg). Clin Gastroenterol Hepatol 2022; 20:2243-2257. [PMID: 34954341 DOI: 10.1016/j.cgh.2021.12.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/14/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS After a first Helicobacter pylori eradication attempt, approximately 20% of patients will remain infected. The aim of the current study was to assess the effectiveness and safety of second-line empiric treatment in Europe. METHODS This international, multicenter, prospective, non-interventional registry aimed to evaluate the decisions and outcomes of H pylori management by European gastroenterologists. All infected adult cases with a previous eradication treatment attempt were registered with the Spanish Association of Gastroenterology-Research Electronic Data Capture until February 2021. Patients allergic to penicillin and those who received susceptibility-guided therapy were excluded. Data monitoring was performed to ensure data quality. RESULTS Overall, 5055 patients received empiric second-line treatment. Triple therapy with amoxicillin and levofloxacin was prescribed most commonly (33%). The overall effectiveness was 82% by modified intention-to-treat analysis and 83% in the per-protocol population. After failure of first-line clarithromycin-containing treatment, optimal eradication (>90%) was obtained with moxifloxacin-containing triple therapy or levofloxacin-containing quadruple therapy (with bismuth). In patients receiving triple therapy containing levofloxacin or moxifloxacin, and levofloxacin-bismuth quadruple treatment, cure rates were optimized with 14-day regimens using high doses of proton pump inhibitors. However, 3-in-1 single capsule or levofloxacin-bismuth quadruple therapy produced reliable eradication rates regardless of proton pump inhibitor dose, duration of therapy, or previous first-line treatment. The overall incidence of adverse events was 28%, and most (85%) were mild. Three patients developed serious adverse events (0.3%) requiring hospitalization. CONCLUSIONS Empiric second-line regimens including 14-day quinolone triple therapies, 14-day levofloxacin-bismuth quadruple therapy, 14-day tetracycline-bismuth classic quadruple therapy, and 10-day bismuth quadruple therapy (as a single capsule) provided optimal effectiveness. However, many other second-line treatments evaluated reported low eradication rates. ClincialTrials.gov number: NCT02328131.
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Affiliation(s)
- Olga P Nyssen
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Dino Vaira
- Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - Ángeles Pérez Aísa
- Department of Gastroenterology, Agencia Sanitaria Costa del Sol, Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Marbella, Spain
| | - Luis Rodrigo
- Department of Gastroenterology, Hospital de Asturias, Oviedo, Spain
| | | | - Laimas Jonaitis
- Department of Gastroenterology, Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Bojan Tepes
- Department of Gastroenterology, AM DC Rogaska, Rogaska Slatina, Slovenia
| | | | - María Caldas
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Angel Lanas
- Department of Gastroenterology, Hospital Clínico Universitario/Instituto de Investigacion Sanitaria Aragón, University of Zaragoza, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Zaragoza, Spain
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain
| | - Luis Bujanda
- Department of Gastroenterology, Hospital Donostia/Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Universidad del País Vasco, San Sebastián, Spain
| | - Juan Ortuño
- Department of Gastroenterology, Hospital Universitari i Politècnic, La Fe, Valencia, Spain
| | - Jesús Barrio
- Department of Gastroenterology, Hospital Río Hortega, Valladolid, Spain
| | - Jose M Huguet
- Department of Gastroenterology, Hospital General Universitario de Valencia, Valencia, Spain
| | - Irina Voynovan
- Department of Gastroenterology, A.S. Loginov Moscow Clinical Scientific Center, Moscow, Russia
| | | | | | | | | | | | - Miguel Areia
- Department of Gastroenterology, Portuguese Oncology Institute Coimbra, Coimbra, Portugal
| | - Antonio Gasbarrini
- Medicina Interna, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Juozas Kupčinskas
- Department of Gastroenterology, Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dmitry Bordin
- Department of Gastroenterology, A.S. Loginov Moscow Clinical Scientific Center, Moscow, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Tver State Medical University, Tver, Russia
| | - Ricardo Marcos-Pinto
- Department of Gastroenterology, Centro Hospitalar do Porto Institute of Biomedical Sciences Abel Salazar, Centro de Investigação em Tecnologias e Serviços de Saúde, University of Porto, Porto, Portugal
| | - Frode Lerang
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway
| | - Marcis Leja
- Department of Gastroenterology, Digestive Diseases Centre Gastro, Institute of Clinical and Preventive Medicine and Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Gyorgy M Buzas
- Department of Gastroenterology, Ferencváros Health Centre, Budapest, Hungary
| | - Yaron Niv
- Department of Gastroenterology, Rabin Medical Center, Tel Aviv University, Petah Tikva, Israel
| | - Theodore Rokkas
- Department of Gastroenterology, Henry Dunant Hospital, Athens, Greece
| | - Perminder Phull
- Department of Gastroenterology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Sinead Smith
- Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Oleg Shvets
- Department of Gastroenterology, Internal Medicine, National Medical University, Kyiv, Ukraine
| | - Marino Venerito
- Department of Gastroenterology, Otto-von-Guericke University, Magdeburg, Germany
| | - Vladimir Milivojevic
- Department of Gastroenterology, Clinical Center of Serbia, University of Belgrade School of Medicine, Belgrade, Serbia
| | - Ilkay Simsek
- Department of Gastroenterology, Internal Medicine, Hacettepe, University School of Medicine, Ankara, Turkey
| | - Vincent Lamy
- Department of Gastroenterology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Peter Bytzer
- Department of Gastroenterology, Clinical Medicine, Zealand University Hospital, Copenhagen University, Copenhagen, Denmark
| | - Lyudmila Boyanova
- Department of Gastroenterology, Medical Microbiology, Medical University of Sofia, Sofia, Bulgaria
| | - Lumír Kunovský
- Department of Gastroenterology and Internal Medicine, Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Michael Doulberis
- Emergency Department, University Hospital Inselspital of Bern, Bern, Switzerland, Second Medical Clinic, School of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Macedonia, Greece, and First Laboratory of Pharmacology, Aristotle University of Thessaloniki, Thessaloniki, Macedonia, Greece
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Adrian Goldis
- Department of Gastroenterology, Timisoara Hospital, Timisoara, Romania
| | - Ante Tonkić
- Department of Gastroenterology, University Hospital of Split, University of Split School of Medicine, Split, Croatia
| | - Lisette Capelle
- Department of Gastroenterology, Meander Medical Center, Amersfoort, The Netherlands
| | - Ignasi Puig
- Department of Gastroenterology, Althaia Xarxa Assistencial Universitària de Manresa, Universitat de Vic-Universitat Central de Catalunya, Manresa, Spain
| | - Francis Megraud
- Institut national de la santé et de la recherche médicale (INSERM) U1312 BRIC Team 4, University of Bordeaux, Bordeaux, France
| | - Colm O' Morain
- Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Javier P Gisbert
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain.
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Effectiveness and Safety of High-Dose Dual Therapy: Results of the European Registry on the Management of Helicobacterpylori Infection (Hp-EuReg). J Clin Med 2022; 11:jcm11123544. [PMID: 35743627 PMCID: PMC9225562 DOI: 10.3390/jcm11123544] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Randomized clinical trials and meta-analyses, primarily from Asian countries, have reported good effectiveness with high-dose dual therapy (HDDT) including a proton pump inhibitor (PPI) and amoxicillin when prescribed as H. pylori first-line or rescue treatment. However, combining amoxicillin with PPIs in the 1990s in several European countries yielded suboptimal results. Methods: An international, multicenter, prospective non-interventional Registry (Hp-EuReg) aimed to evaluate the decisions and outcomes of H. pylori management by European gastroenterologists. All infected adult cases treated with HDDT were registered at e-CRF AEG-REDCap platform until June 2021. Sixty patients were prescribed with HDDT (98% compliance), 19 of them received a first-line therapy and 41 a rescue treatment (second- to sixth-line). Results: Overall HDDT effectiveness was 52% (per-protocol) and 51% (modified intention-to-treat). First-line and rescue treatment lines were equally effective, but the effectiveness was worse when patients had previously received metronidazole, tetracycline, or rifabutin. Adding bismuth to HDDT in rescue treatment did not yield better results. The incidence of adverse events was 30%, diarrhea being the most common (20% of patients); no serious adverse events were reported. Conclusion: Although HDDT is safe and has good compliance, it is not a good option in European first-line or rescue H. pylori treatment, even when adding bismuth.
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Management of Helicobacter Pylori Infection and Effectiveness Rates in Daily Clinical Practice in Spain: 2010–2019. Antibiotics (Basel) 2022; 11:antibiotics11050698. [PMID: 35625342 PMCID: PMC9171584 DOI: 10.3390/antibiotics11050698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 02/04/2023] Open
Abstract
The management and effectiveness of the treatment of Helicobacter pylori infection are heterogeneous worldwide, despite the publication of international consensus conferences and guidelines, which have been widely available for years. The aim of the study was to describe the clinical management and the eradication rates in a region of Southern Europe (Spain). Between 2010 and 2019, we conducted a retrospective analysis of patients with H. pylori infection attended by gastroenterologists in two defined areas of the National Health System in Aragón. We compared the appropriateness of therapies according to guidelines, and described the effectiveness of each treatment. A total of 1644 penicillin non-allergic patients were included. The most prescribed therapy between 2010 and 2013 was the ‘classic’ triple therapy PCA (80%), whereas the ’concomitant’ therapy PCAM was chosen by 90% of the gastroenterologists in 2015. After 2016, the use of the quadruple bismuth-containing therapy in a single capsule (Pylera®) quickly increased, representing almost half of the overall prescriptions in 2019. Throughout the decade, adherence to guidelines was 76.4% and global efficacy was 70.7% (ITT). Triple therapies’ eradication rates were lower than 70% (ITT), whereas eradication rates with quadruple therapies achieved or were over 80% (ITT). In conclusion, despite the use of quadruple therapies and optimized treatments, the effectiveness of H. pylori management in daily clinical practice is far from the target of 90%.
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Gisbert JP, Alcedo J, Amador J, Bujanda L, Calvet X, Castro-Fernández M, Fernández-Salazar L, Gené E, Lanas Á, Lucendo AJ, Molina-Infante J, Nyssen OP, Pérez-Aisa A, Puig I. V Spanish Consensus Conference on Helicobacter pylori infection treatment. GASTROENTEROLOGIA Y HEPATOLOGIA 2022; 45:392-417. [PMID: 34629204 DOI: 10.1016/j.gastrohep.2021.07.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/30/2021] [Accepted: 07/16/2021] [Indexed: 02/07/2023]
Abstract
Helicobacter pylori infection is very common in the Spanish population and represents the main cause of chronic gastritis, peptic ulcer, and gastric cancer. The last iteration of Spanish consensus guidelines on H. pylori infection was conducted in 2016. Recent changes in therapeutic schemes along with increasing supporting evidence were key for developing the V Spanish Consensus Conference (May 2021). Fourteen experts performed a systematic review of the scientific evidence and developed a series of recommendations that were subjected to an anonymous Delphi process of iterative voting. Scientific evidence and the strength of the recommendation were classified using GRADE guidelines. An eradication therapy, when prescribed empirically, is considered acceptable when it reliably achieves, or preferably surpass, 90% cure rates. Currently, only quadruple therapies (with or without bismuth) and generally lasting 14 days, accomplish this goal in first- and second-line therapies. A non-bismuth quadruple concomitant regimen (proton pump inhibitor, clarithromycin, amoxicillin, and metronidazole) or a quadruple bismuth-based combination (proton pump inhibitor, bismuth, tetracycline, and metronidazole), are recommended as first-line regimens. Rescue therapies after eradication failure and management of H. pylori infection in peptic ulcer disease were also reviewed.
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Affiliation(s)
- Javier P Gisbert
- Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España.
| | - Javier Alcedo
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España
| | - Javier Amador
- Medicina de Familia, Centro de Salud Los Ángeles, Dirección Asistencial Centro, SERMAS, Madrid, España
| | - Luis Bujanda
- Servicio de Aparato Digestivo, Hospital Donostia/Instituto Biodonostia, Universidad del País Vasco UPV/EHU, CIBEREHD, San Sebastián, España
| | - Xavier Calvet
- Servicio de Aparato Digestivo, Hospital Parc Taulí, Universitat Autónoma de Barcelona, CIBEREHD, Sabadell, Barcelona, España
| | | | - Luis Fernández-Salazar
- Servicio de Aparato Digestivo, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud (SACYL), Universidad de Valladolid, Valladolid, España
| | - Emili Gené
- Servicio de Urgencias, Hospital Parc Taulí Sabadell, CIBEREHD, Universitat Internacional de Catalunya, Barcelona, España
| | - Ángel Lanas
- Servicio de Aparato Digestivo, Hospital Clínico Universitario de Zaragoza, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), CIBEREHD, Zaragoza
| | - Alfredo J Lucendo
- Servicio de Aparato Digestivo, Hospital General de Tomelloso, CIBEREHD, Ciudad Real, España
| | - Javier Molina-Infante
- Servicio de Aparato Digestivo, Hospital Universitario de Cáceres, CIBEREHD, Cáceres, España
| | - Olga P Nyssen
- Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España
| | - A Pérez-Aisa
- Servicio de Aparato Digestivo, Agencia Sanitaria Costa del Sol, Marbella, Málaga, España
| | - Ignasi Puig
- Servicio de Aparato Digestivo, Althaia Xarxa Assistencial Universitària de Manresa, Universitat de Vic-Universitat Central de Catalunya (UVicUCC), Manresa, Barcelona, España
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Helicobacter pylori Infection in Croatian Population: Knowledge, Attitudes and Factors Influencing Incidence and Recovery. Healthcare (Basel) 2022; 10:healthcare10050833. [PMID: 35627971 PMCID: PMC9141647 DOI: 10.3390/healthcare10050833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/19/2022] [Accepted: 04/29/2022] [Indexed: 12/04/2022] Open
Abstract
Basic and clinical knowledge about Helicobacter pylori infections has been improved in the past. However, the translation of this knowledge into public health intervention has remained poor. A survey based cross-sectional study was performed to assess the factors regarding the H. pylori infection in the general population. The survey was conducted using a previously developed questionnaire, adapted for the population in Croatia. Respondents (N = 1131) had a good knowledge score with a median of 4 out of 5 correct answers (interquartile range: 2–4). Senior participants had a lower frequency of high knowledge answers about H. pylori (43.1%) compared to younger (56.1%) and middle-aged participants (51.5%, p = 0.014). Rural participants had a higher frequency of low knowledge answers compared to urban and suburban ones (21.7% vs. 9.5% and 9.4%, p = 0.011). Only 315 participants (27.9%) were screened for the H. pylori infection, despite high support for the screening programs among the untested (74.7%) and tested (85.7%). Habits of smoking (p = 0.036) and coffee drinking (p = 0.008) were associated with more symptoms after eradication therapy. Further education is needed for the groups at risk for H. pylori infection, especially to raise the awareness of the importance of screening programs. More research is warranted to assess the effects of dietary changes on therapy outcomes.
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Shah S, Hubscher E, Pelletier C, Jacob R, Vinals L, Yadlapati R. Helicobacter pylori infection treatment in the United States: clinical consequences and costs of eradication treatment failure. Expert Rev Gastroenterol Hepatol 2022; 16:341-357. [PMID: 35315732 DOI: 10.1080/17474124.2022.2056015] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Helicobacter pylori (Hp) is causal in benign and malignant gastrointestinal diseases. Accordingly, current guidelines recommend Hp eradication in patients with active infection. Unfortunately, treatment failure is common, exposing patients to complications associated with persistent Hp infection and consequences of repeated treatment, including promotion of antibiotic resistance. In the United States (US), data regarding eradication rates with available therapies are limited. Moreover, the clinical and economic burden of eradication treatment failure have not been thoroughly described. AREAS COVERED We aimed to characterize Hp eradication rates and the clinical consequences and associated costs of persistent Hp infection among US adults. We conducted focused literature reviews using initial searches in Embase, MEDLINE, and Cochrane Database of Systematic Reviews via Ovid followed by manual searches to identify relevant publications. EXPERT OPINION Hp eradication rates were suboptimal, with most studies reporting rates ≤80% with clarithromycin-based triple therapy and bismuth quadruple therapy. There was direct evidence supporting numerous benefits of successful Hp eradication, including decreased risk of recurrent or complicated peptic disease and non-cardia gastric cancer. Cost benefits of eradication were related to mitigation of conditions associated with persistent Hp infection, (e.g. complicated peptic ulcer disease, and gastric cancer) which altogether exceed US$5.3 billion.
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Affiliation(s)
- Shailja Shah
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | | | - Corey Pelletier
- HEOR, Phathom Pharmaceuticals, Florham Park, New Jersey, USA
| | - Rinu Jacob
- Medical Affairs, Phathom Pharmaceuticals, Florham Park, New Jersey, USA
| | - Lydia Vinals
- Real-World Advanced Analytics, Cytel, Inc, Waltham, Massachusetts, USA
| | - Rena Yadlapati
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
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Nyssen OP, Vaira D, Saracino IM, Fiorini G, Caldas M, Bujanda L, Pellicano R, Keco-Huerga A, Pabón-Carrasco M, Oblitas Susanibar E, Di Leo A, Losurdo G, Pérez-Aísa Á, Gasbarrini A, Boltin D, Smith S, Phull P, Rokkas T, Lamarque D, Cano-Català A, Puig I, Mégraud F, O’Morain C, Gisbert JP. Experience with Rifabutin-Containing Therapy in 500 Patients from the European Registry on Helicobacter pylori Management (Hp-EuReg). J Clin Med 2022; 11:jcm11061658. [PMID: 35329984 PMCID: PMC8949410 DOI: 10.3390/jcm11061658] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND First-line Helicobacter pylori (H. pylori) treatments have been relatively well evaluated; however, it remains necessary to identify the most effective rescue treatments. Our aim was to assess the effectiveness and safety of H. pylori regimens containing rifabutin. METHODS International multicentre prospective non-interventional European Registry on H. pylori Management (Hp-EuReg). Patients treated with rifabutin were registered in AEG-REDCap e-CRF from 2013 to 2021. Modified intention-to-treat and per-protocol analyses were performed. Data were subject to quality control. RESULTS Overall, 500 patients included in the Hp-EuReg were treated with rifabutin (mean age 52 years, 72% female, 63% with dyspepsia, 4% with peptic ulcer). Culture was performed in 63% of cases: dual resistance (to both clarithromycin and metronidazole) was reported in 46% of the cases, and triple resistance (to clarithromycin, metronidazole, and levofloxacin) in 39%. In 87% of cases rifabutin was utilised as part of a triple therapy together with amoxicillin and a proton-pump-inhibitor, and in an additional 6% of the patients, bismuth was added to this triple regimen. Rifabutin was mainly used in second-line (32%), third-line (25%), and fourth-line (27%) regimens, achieving overall 78%, 80% and 66% effectiveness by modified intention-to-treat, respectively. Compliance with treatment was 89%. At least one adverse event was registered in 26% of the patients (most frequently nausea), and one serious adverse event (0.2%) was reported in one patient with leukopenia and thrombocytopenia with fever requiring hospitalisation. CONCLUSION Rifabutin-containing therapy represents an effective and safe strategy after one or even several failures of H. pylori eradication treatment.
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Affiliation(s)
- Olga P. Nyssen
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain; (O.P.N.); (M.C.)
| | - Dino Vaira
- Department of Surgical and Medical Sciences, IRCCS S. Orsola, University of Bologna, 40138 Bologna, Italy; (D.V.); (I.M.S.); (G.F.)
| | - Ilaria Maria Saracino
- Department of Surgical and Medical Sciences, IRCCS S. Orsola, University of Bologna, 40138 Bologna, Italy; (D.V.); (I.M.S.); (G.F.)
| | - Giulia Fiorini
- Department of Surgical and Medical Sciences, IRCCS S. Orsola, University of Bologna, 40138 Bologna, Italy; (D.V.); (I.M.S.); (G.F.)
| | - María Caldas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain; (O.P.N.); (M.C.)
| | - Luis Bujanda
- Hospital Donostia, Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), 20014 San Sebastián, Spain;
| | | | - Alma Keco-Huerga
- Servicio de Gastroenterolgía, Hospital de Valme, 41014 Sevilla, Spain; (A.K.-H.); (M.P.-C.)
| | - Manuel Pabón-Carrasco
- Servicio de Gastroenterolgía, Hospital de Valme, 41014 Sevilla, Spain; (A.K.-H.); (M.P.-C.)
| | | | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University Hospital Policlinico Consorziale, 70124 Bari, Italy; (A.D.L.); (G.L.)
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University Hospital Policlinico Consorziale, 70124 Bari, Italy; (A.D.L.); (G.L.)
| | - Ángeles Pérez-Aísa
- Agencia Sanitaria Costa del Sol, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 29651 Marbella, Spain;
| | - Antonio Gasbarrini
- Medicina Interna, Fondazione Policlinico Universitario A, Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy;
| | - Doron Boltin
- Division of Gastroenterology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 49100, Israel;
| | - Sinead Smith
- Faculty of Health Sciences, Trinity College Dublin, D02PN40 Dublin, Ireland; (S.S.); (C.O.)
| | - Perminder Phull
- Department of Digestive Disorders, Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen AB25 2ZN, UK;
| | - Theodore Rokkas
- Gastroenterology Clinic, Henry Dunant Hospital, 11526 Athens, Greece;
| | - Dominique Lamarque
- Hôpital Ambroise Paré, Université de Versailles St-Quentin en Yvelines, Boulogne Billancourt, 92100 Paris, France;
| | - Anna Cano-Català
- Gastroenterology Service, Althaia Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain; (A.C.-C.); (I.P.)
- Medicine Department, Universitat de Vic-Universitat Central de Catalunya (UVicUCC), 08500 Manresa, Spain
| | - Ignasi Puig
- Gastroenterology Service, Althaia Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain; (A.C.-C.); (I.P.)
- Medicine Department, Universitat de Vic-Universitat Central de Catalunya (UVicUCC), 08500 Manresa, Spain
| | - Francis Mégraud
- INSERM U1312, Université de Bordeaux, 33076 Bordeaux, France;
| | - Colm O’Morain
- Faculty of Health Sciences, Trinity College Dublin, D02PN40 Dublin, Ireland; (S.S.); (C.O.)
| | - Javier P. Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain; (O.P.N.); (M.C.)
- Correspondence: ; Tel.: +349-1309-3911; Fax: +349-1520-4013
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Nyssen OP, Vaira D, Tepes B, Kupcinskas L, Bordin D, Pérez-Aisa Á, Gasbarrini A, Castro-Fernández M, Bujanda L, Garre A, Lucendo A, Vologzhanina L, Jurecic NB, Rodrigo-Sáez L, Huguet JM, Voynovan I, Perez-Lasala J, Romero PM, Vujasinovic M, Abdulkhakov R, Barrio J, Fernandez-Salazar L, Mégraud F, O'Morain C, Gisbert JP. Room for Improvement in the Treatment of Helicobacter pylori Infection: Lessons from the European Registry on H. pylori Management (Hp-EuReg). J Clin Gastroenterol 2022; 56:e98-e108. [PMID: 33405435 DOI: 10.1097/mcg.0000000000001482] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Managing Helicobacter pylori infection requires constant decision making, and each decision is open to possible errors. AIM The aim was to evaluate common mistakes in the eradication of H. pylori, based on the "European Registry on Helicobacter pylori management". METHODS European Registry on Helicobacter pylori management is an international multicentre prospective noninterventional registry evaluating the decisions and outcomes of H. pylori management by European gastroenterologists in routine clinical practice. RESULTS Countries recruiting more than 1000 patients were included (26,340 patients). The most common mistakes (percentages) were: (1) To use the standard triple therapy where it is ineffective (46%). (2) To prescribe eradication therapy for only 7 to 10 days (69%). (3) To use a low dose of proton pump inhibitors (48%). (4) In patients allergic to penicillin, to prescribe always a triple therapy with clarithromycin and metronidazole (38%). (5) To repeat certain antibiotics after eradication failure (>15%). (6) Failing to consider the importance of compliance with treatment (2%). (7) Not to check the eradication success (6%). Time-trend analyses showed progressive greater compliance with current clinical guidelines. CONCLUSION The management of H. pylori infection by some European gastroenterologists is heterogeneous, frequently suboptimal and discrepant with current recommendations. Clinical practice is constantly adapting to updated recommendations, although this shift is delayed and slow.
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Affiliation(s)
- Olga P Nyssen
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
| | - Dino Vaira
- Department of Surgical and Clinical Sciences, University of Bologna, Bologna
| | - Bojan Tepes
- Gastroenterology Unit, AM DC Rogaska, Rogaska Slatina
| | - Limas Kupcinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dmitry Bordin
- Department of Pancreatobiliary and Upper GI Diseases, Moscow Clinical Scientific Center, and A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow
| | - Ángeles Pérez-Aisa
- Digestive Unit, Agencia Sanitaria Costa del Sol, Marbella, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Málaga
| | - Antonio Gasbarrini
- Gastronterology Area, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | | | - Luis Bujanda
- Department of Gastroenterology, Hospital Donostia/Instituto Biodonostia. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd). Universidad del País Vasco (UPV/EHU), Donostia
| | - Ana Garre
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
| | | | | | | | - Luis Rodrigo-Sáez
- Gastroenterology Unit, Hospital Universitario Central de Asturias, Oviedo
| | - Jose M Huguet
- Hospital General Universitario de Valencia, Valencia
| | - Irina Voynovan
- Department of Pancreatobiliary and Upper GI Diseases, Moscow Clinical Scientific Center, and A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow
| | | | | | | | | | | | | | - Francis Mégraud
- Laboratoire de Bactériologie, Hôpital Pellegrin, Bordeaux Cedex, France
| | - Colm O'Morain
- Trinity College Dublin, Faculty of Health Sciences, Trinity College Dublin, Dublin/IE, Faculty of Health Sciences, Dublin, Ireland
| | - Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
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23
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Rokkas T, Georgopoulos S, Michopoulos S, Ntouli V, Liatsos C, Puig I, Nyssen OP, Mégraud F, O'Morain C, Gisbert JP. Assessment of first-line eradication treatment in Greece: data from the European Registry on Helicobacter pylori management (Hp-EuReg). Ann Gastroenterol 2022; 35:42-47. [PMID: 34987287 PMCID: PMC8713343 DOI: 10.20524/aog.2021.0670] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background Helicobacter pylori (H. pylori) is the most common chronic bacterial infection. Its management has to rely on local effectiveness, given the geographical variability of bacterial antibiotic resistance. We evaluated treatment effectiveness in naïve patients in Greece, as part of the European Registry on the management of H. pylori (Hp-EuReg). Methods Patients were registered in the AEG-REDCap Electronic Case Report Form from 2013-2020. All cases with a first-line treatment were included. Modified intention-to-treat (mITT) analysis was used. Results A total of 547 patients from 5 medical institutions were treated with the following regimens: concomitant with proton pump inhibitors (PPIs), clarithromycin, amoxicillin and metronidazole (concomitant-C+A+M) (38%); hybrid with PPI, clarithromycin, amoxicillin and metronidazole (hybrid-C+A+M) (20%); sequential with PPI, clarithromycin, amoxicillin and tinidazole (sequential-C+A+T) (12%); sequential with PPI, clarithromycin, amoxicillin and metronidazole (sequential-C+A+M) (12%); concomitant with PPI, clarithromycin, amoxicillin and tinidazole (concomitant-C+A+T) (8%); triple with PPI, clarithromycin and amoxicillin (triple-C+A) (7%); and other (3%). Overall compliance was 99%. Triple-C+A, sequential-C+A+T, sequential-C+A+M and concomitant-C+A+T were used from 2013-2015. The respective mITT cure rates (95% confidence interval) were 92% (78-98), 87% (76-94), 67% (54-78) and 91% (79-98). Since 2015, patients were also treated with concomitant-C+A+M and hybrid-C+A+M regimens, with respective mITT cure rates of 90% (85-94) and 88% (80.5-94). Adverse events were reported by 31% of the patients, dysgeusia being the most frequent (15%). Conclusions “Optimized” H. pylori therapies should achieve cure rates over 90%. In Greece, at present, only non-bismuth quadruple concomitant regimens achieve this target and can be recommended as first-line treatment.
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Affiliation(s)
- Theodore Rokkas
- Department of Gastroenterology, Henry Dunant Hospital, Athens, Greece (Theodore Rokkas)
| | - Sotirios Georgopoulos
- Department of Gastroenterology, Athens Medical Paleo Faliron Hospital, Athens, Greece (Sotirios Georgopoulos)
| | - Spyros Michopoulos
- Department of Gastroenterology, Alexandra's Hospital, Athens, Greece (Spyros Michopoulos)
| | - Vasiliki Ntouli
- Department of Gastroenterology, Tzaneio General Hospital of Piraeus, Piraeus, Greece (Vasiliki Ntouli)
| | - Christos Liatsos
- Department of Gastroenterology, 401 Military Hospital, Athens, Greece (Christos Liatsos)
| | - Ignasi Puig
- Department of Gastroenterology, Althaia Xarxa Assistencial Universitària de Manresa and Universitat de Vic-Universitat Central de Catalunya (UVicUCC), Manresa, Spain (Ignasi Puig)
| | - Olga P Nyssen
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain (Olga P. Nyssen, Javier P. Gisbert)
| | - Francis Mégraud
- Laboratoire de Bactériologie, Hôpital Pellegrin, Bordeaux, France (Francis Mégraud)
| | - Colm O'Morain
- Trinity College Dublin, Dublin, Ireland (Colm O'Morain)
| | - Javier P Gisbert
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain (Olga P. Nyssen, Javier P. Gisbert)
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Bordin DS. Errors in the diagnosis and treatment of <i>Helicobacter pylori</i> infection: in anticipation of new conciliation documents. EXPERIMENTAL AND CLINICAL GASTROENTEROLOGY 2021:5-14. [DOI: 10.31146/1682-8658-ecg-193-9-5-14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
The high prevalence of H. pylori and diseases caused by this infection determine the relevance of discussing the problems of its diagnosis and treatment on the eve of the emergence of new international and domestic agreements. Studies published in recent years, including articles on the materials of the European Registry on the management of Helicobacter pylori infection (Hp-EuReg), provide a rich background for the analysis of errors in diagnosis and treatment of this infection, and the development of approaches to optimize clinical practice.
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Affiliation(s)
- D. S. Bordin
- A.S. Loginov Moscow clinical scientific center; Tver State Medical University; A.I. Yevdokimov Moscow State University of Medicine and Dentistry
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25
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Bordin DS. Errors in the diagnosis and treatment of <i>Helicobacter pylori</i> infection: in anticipation of new conciliation documents. EXPERIMENTAL AND CLINICAL GASTROENTEROLOGY 2021:5-14. [DOI: https:/doi.org/10.31146/1682-8658-ecg-193-9-5-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
The high prevalence of H. pylori and diseases caused by this infection determine the relevance of discussing the problems of its diagnosis and treatment on the eve of the emergence of new international and domestic agreements. Studies published in recent years, including articles on the materials of the European Registry on the management of Helicobacter pylori infection (Hp-EuReg), provide a rich background for the analysis of errors in diagnosis and treatment of this infection, and the development of approaches to optimize clinical practice.
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Affiliation(s)
- D. S. Bordin
- A.S. Loginov Moscow clinical scientific center; Tver State Medical University; A.I. Yevdokimov Moscow State University of Medicine and Dentistry
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Antibiotic Resistance Prevalence and Trends in Patients Infected with Helicobacter pylori in the Period 2013-2020: Results of the European Registry on H. pylori Management (Hp-EuReg). Antibiotics (Basel) 2021; 10:antibiotics10091058. [PMID: 34572640 PMCID: PMC8471667 DOI: 10.3390/antibiotics10091058] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Bacterial antibiotic resistance changes over time depending on multiple factors; therefore, it is essential to monitor the susceptibility trends to reduce the resistance impact on the effectiveness of various treatments. Objective: To conduct a time-trend analysis of Helicobacter pylori resistance to antibiotics in Europe. Methods: The international prospective European Registry on Helicobacter pylori Management (Hp-EuReg) collected data on all infected adult patients diagnosed with culture and antimicrobial susceptibility testing positive results that were registered at AEG-REDCap e-CRF until December 2020. Results: Overall, 41,562 patients were included in the Hp-EuReg. Culture and antimicrobial susceptibility testing were performed on gastric biopsies of 3974 (9.5%) patients, of whom 2852 (7%) were naive cases included for analysis. The number of positive cultures decreased by 35% from the period 2013–2016 to 2017–2020. Concerning naïve patients, no antibiotic resistance was found in 48% of the cases. The most frequent resistances were reported against metronidazole (30%), clarithromycin (25%), and levofloxacin (20%), whereas resistances to tetracycline and amoxicillin were below 1%. Dual and triple resistances were found in 13% and 6% of the cases, respectively. A decrease (p < 0.001) in the metronidazole resistance rate was observed between the 2013–2016 (33%) and 2017–2020 (24%) periods. Conclusion: Culture and antimicrobial susceptibility testing for Helicobacter pylori are scarcely performed (<10%) in Europe. In naïve patients, Helicobacter pylori resistance to clarithromycin remained above 15% throughout the period 2013–2020 and resistance to levofloxacin, as well as dual or triple resistances, were high. A progressive decrease in metronidazole resistance was observed.
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The Role of Statins on Helicobacter pylori Eradication: Results from the European Registry on the Management of H. pylori (Hp-EuReg). Antibiotics (Basel) 2021; 10:antibiotics10080965. [PMID: 34439015 PMCID: PMC8388917 DOI: 10.3390/antibiotics10080965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/19/2021] [Accepted: 08/03/2021] [Indexed: 12/20/2022] Open
Abstract
Statins could increase the effectiveness of Helicobacter pylori eradication therapies due to their anti-inflammatory effect. The aim of this study was to analyze the impact of this therapeutic association in real life. This is a multicenter, prospective, non-interventional study aimed at evaluating the management of H. pylori by European gastroenterologists. Patients were registered in an e-CRF by AEG-REDCap from 2013 to 2020. The association between statin use and H. pylori eradication effectiveness was evaluated through multivariate analysis. Overall, 9988 and 705 patients received empirical and culture-guided treatment, respectively. Overall, statin use was associated with higher effectiveness in the empirical group (OR = 1.3; 95%CI = 1.1–1.5), but no association was found with first-line treatment effectiveness (N = 7738); as an exception, statin use was specifically associated with lower effectiveness of standard triple therapy (OR = 0.76; 95%CI = 0.59–0.99). In the rescue therapy empirical group (N = 2228), statins were associated with higher overall effectiveness (OR = 1.9; 95%CI = 1.4–2.6). However, sub-analyses by treatment schemes only confirmed this association for the single-capsule bismuth quadruple therapy (OR = 2.8; 95%CI = 1.3–5.7). No consistent association was found between statin use and H. pylori therapy effectiveness. Therefore, the addition of statins to the usual H. pylori treatment cannot be currently recommended to improve cure rates.
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Jonaitis P, Kupcinskas J, Nyssen OP, Puig I, Gisbert JP, Jonaitis L. Evaluation of the Effectiveness of Helicobacter pylori Eradication Regimens in Lithuania during the Years 2013-2020: Data from the European Registry on Helicobacter pylori Management (Hp-EuReg). ACTA ACUST UNITED AC 2021; 57:medicina57070642. [PMID: 34201428 PMCID: PMC8305910 DOI: 10.3390/medicina57070642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 12/11/2022]
Abstract
Background and Objectives: The prevalence of H. pylori in Eastern Europe remains quite high; however, there is insufficient data on the eradication regimens and their effectiveness. Therefore, the objective of the study was to evaluate the diagnostic methods and treatment of H. pylori infection as well as their adherence to Maastricht V/Florence consensus during the years 2013–2020 in Lithuania. Materials and Methods: Sub-study of the “European Registry on H. pylori Management” (Hp-EuReg), international multicenter prospective non-interventional registry of the routine clinical practice. Lithuanian data from the years 2013–2020 were analyzed for effectiveness on a modified intention-to-treat (mITT) basis. 2000 adult patients, diagnosed with H. pylori infection, were included. Data were compared to the European Maastricht V guidelines. Results: Triple-therapy was used in 90% of the cases. In 91% of the first-line prescriptions, standard triple therapy (STT) was used. The most common second-line treatment was a combination of PPI, amoxicillin and levofloxacin (PPI+A+L) (47%). The overall effectiveness in 552 cases valid for analysis was 90% by mITT. In first-line treatment, the STT effectiveness was 90% and second-line treatment with PPI+A+L achieved 92% by mITT. Increasing overall H. pylori eradication rates were observed: from 72% in 2013 to more than 90% in 2018–2020, as well as a shift from 7 to 10–14 days treatments duration throughout 2013–2020. Conclusions: In Lithuania, the prescribed eradication regimens for H. pylori were in accordance with the international guidelines but diagnostic methods and treatment duration only partially met Maastricht V/Florence guidelines. The eradication effectiveness was improved progressively during the years 2018–2020, reaching ≥90% cure rates.
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Affiliation(s)
- Paulius Jonaitis
- Department of Gastroenterology, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania; (P.J.); (J.K.)
| | - Juozas Kupcinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania; (P.J.); (J.K.)
| | - Olga P. Nyssen
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain; (O.P.N.); (J.P.G.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
| | - Ignasi Puig
- Digestive Diseases Department, Althaia Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain;
- Department of Medicine, Facultat de Ciències de la Salut, Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), 08500 Manresa, Spain
| | - Javier P. Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain; (O.P.N.); (J.P.G.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
| | - Laimas Jonaitis
- Department of Gastroenterology, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania; (P.J.); (J.K.)
- Correspondence: ; Tel.: +370-37-326264
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29
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Nyssen OP, Perez-Aisa A, Tepes B, Castro-Fernandez M, Kupcinskas J, Jonaitis L, Bujanda L, Lucendo A, Jurecic NB, Perez-Lasala J, Shvets O, Fadeenko G, Huguet JM, Kikec Z, Bordin D, Voynovan I, Leja M, Machado JC, Areia M, Fernandez-Salazar L, Rodrigo L, Alekseenko S, Barrio J, Ortuño J, Perona M, Vologzhanina L, Romero PM, Zaytsev O, Rokkas T, Georgopoulos S, Pellicano R, Buzas GM, Modolell I, Gomez Rodriguez BJ, Simsek I, Simsek C, Lafuente MR, Ilchishina T, Camarero JG, Dominguez-Cajal M, Ntouli V, Dekhnich NN, Phull P, Nuñez O, Lerang F, Venerito M, Heluwaert F, Tonkic A, Caldas M, Puig I, Megraud F, O'Morain C, Gisbert JP. Adverse Event Profile During the Treatment of Helicobacter pylori: A Real-World Experience of 22,000 Patients From the European Registry on H. pylori Management (Hp-EuReg). Am J Gastroenterol 2021; 116:1220-1229. [PMID: 33840725 DOI: 10.14309/ajg.0000000000001246] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 02/23/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The safety of Helicobacter pylori eradication treatments and to what extent adverse events (AEs) influence therapeutic compliance in clinical practice are hardly known. Our aim was to assess the frequency, type, intensity, and duration of AEs, and their impact on compliance, for the most frequently used treatments in the "European Registry on Helicobacter pylori management." METHODS Systematic prospective noninterventional registry of the clinical practice of European gastroenterologists (27 countries, 300 investigators) on the management of H. pylori infection in routine clinical practice. All prescribed eradication treatments and their corresponding safety profile were recorded. AEs were classified depending on the intensity of symptoms as mild/moderate/severe and as serious AEs. All data were subject to quality control. RESULTS The different treatments prescribed to 22,492 patients caused at least 1 AE in 23% of the cases; the classic bismuth-based quadruple therapy was the worst tolerated (37% of AEs). Taste disturbance (7%), diarrhea (7%), nausea (6%), and abdominal pain (3%) were the most frequent AEs. The majority of AEs were mild (57%), 6% were severe, and only 0.08% were serious, with an average duration of 7 days. The treatment compliance rate was 97%. Only 1.3% of the patients discontinued treatment due to AEs. Longer treatment durations were significantly associated with a higher incidence of AEs in standard triple, concomitant, bismuth quadruple, and levofloxacin triple or quadruple therapies. DISCUSSION Helicobacter pylori eradication treatment frequently induces AEs, although they are usually mild and of limited duration. Their appearance does not interfere significantly with treatment compliance.
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Affiliation(s)
- Olga P Nyssen
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Angeles Perez-Aisa
- Gastroenterology Unit, Agencia Sanitaria Costa del Sol, Marbella, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Málaga, Spain
| | - Bojan Tepes
- Gastroenterology Unit, AM DC Rogaska, Rogaska Slatina, Slovenia
| | | | - Juozas Kupcinskas
- Gastroenterology Unit, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Laimas Jonaitis
- Gastroenterology Unit, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Luis Bujanda
- Gastroenterology Unit, Hospital Donostia/Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | - Alfredo Lucendo
- Gastroenterology Unit, Hospital de Tomelloso, Ciudad Real, Spain
| | | | | | - Oleg Shvets
- Gastroenterology Unit, Internal Diseases Department No. 1, National Medical University named after O.O. Bogomolets, Kyiv, Ukraine
| | - Galina Fadeenko
- Gastroenterology Unit, National Ukrainian Academy of Medical Sciences, Ukraine
| | - Jose M Huguet
- Gastroenterology Unit, Consorci Hospital General Universitari Valencia, Spain
| | - Zdenki Kikec
- Gastroenterology Unit, Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
| | - Dmitry Bordin
- Gastroenterology Unit, A. S. Loginov Moscow Clinical Scientific Center, Moscow, Russia
- Gastroenterology Unit, Department of Outpatient Therapy and Family Medicine, Tver State Medical University, Tver, Russia
- Gastroenterology Unit, Department of Propaedeutic of Internal diseases and Gastroenterology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Irina Voynovan
- Gastroenterology Unit, A. S. Loginov Moscow Clinical Scientific Center, Moscow, Russia
| | - Marcis Leja
- Gastroenterology Unit, Digestive Diseases Center GASTRO, Riga, Latvia
| | - Jose Carlos Machado
- Gastroenterology Unit, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, and Ipatimup-Institute of Molecular Pathology and Immunology of the University of Porto, Portugal
| | - Miguel Areia
- Gastroenterology Unit, Portuguese Oncology Institute of Coimbra, Portugal
| | | | - Luis Rodrigo
- Gastroenterology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Sergey Alekseenko
- Gastroenterology Unit, Far Eastern State Medical University Khabarovsk, Russia
| | - Jesus Barrio
- Gastroenterology Unit, Hospital Rio Hortega, Valladolid, Spain
| | - Juan Ortuño
- Gastroenterology Unit, Hospital Universitari I Politècnic La Fe Valencia, Spain
| | - Monica Perona
- Gastroenterology Unit, Hospital Quiron Marbella, Spain
| | | | - Pilar Mata Romero
- Gastroenterology Unit, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Oleg Zaytsev
- Gastroenterology Unit, First Clinical Medical Center Kovrov, Russia
| | - Theodore Rokkas
- Gastroenterology Unit, Henry Dunant Hospital, Athens, Greece
| | - Sotirios Georgopoulos
- Gastroenterology Unit, Athens Medical Center, Paleo Faliron General Hospital Athens, Greece
| | | | - Gyorgy M Buzas
- Gastroenterology Unit, Ferencváros Policlinic, Budapest, Hungary
| | - Ines Modolell
- Gastroenterology Unit, Consorci Sanitari Terrassa, Spain
| | | | - Ilkay Simsek
- Gastroenterology Unit, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Cem Simsek
- Gastroenterology Unit, Hacettepe University Ankara, Turkey
| | | | | | | | | | | | | | - Perminder Phull
- Gastroenterology Unit, Aberdeen Royal Infirmary Aberdeen, United Kingdom
| | - Oscar Nuñez
- Gastroenterology Unit, Hospital Universitario Sanitas La Moraleja, Madrid, Spain
| | - Frode Lerang
- Gastroenterology Unit, Medical Department, Central Hospital Ostfold, Fredrikstad, Norway
| | - Marino Venerito
- Gastroenterology Unit, Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - Frederic Heluwaert
- Gastroenterology Unit, Center Hospitalier Annecy Genvois, Pringy, France
| | - Ante Tonkic
- Gastroenterology Unit, University Hospital of Split, School of Medicine, University of Split, Croatia
| | - Maria Caldas
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Ignasi Puig
- Gastroenterology Unit, Althaia Xarxa Assistencial Universitària de Manresa and Universitat de Vic-Universitat Central de Catalunya (UVicUCC), Manresa, Spain
| | - Francis Megraud
- Gastroenterology Unit, Laboratoire de Bactériologie, Hôpital Pellegrin, Bordeaux, France
| | - Colm O'Morain
- Gastroenterology Unit, Department of Clinical Medicine, Trinity College Dublin, Ireland
| | - Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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Nyssen OP, Perez-Aisa A, Castro-Fernandez M, Pellicano R, Huguet JM, Rodrigo L, Ortuñ J, O, Gomez-Rodriguez BJ, Pinto RM, Areia M, Perona M, Nuñez O, Romano M, Gravina AG, Pozzati L, Fernandez-Bermejo M, Venerito M, Malfertheiner P, Fernanadez-Salazar L, Gasbarrini A, Vaira D, Puig I, Megraud F, O'Morain C, Gisbert JP. European Registry on Helicobacter pylori management: Single-capsule bismuth quadruple therapy is effective in real-world clinical practice. United European Gastroenterol J 2021; 9:38-46. [PMID: 33176617 PMCID: PMC8259339 DOI: 10.1177/2050640620972615] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/13/2020] [Indexed: 12/11/2022] Open
Abstract
Background There has been resurgence in the use of bismuth quadruple therapy (proton pump inhibitor, bismuth, tetracycline and metronidazole) for treating Helicobacter pylori infection thanks to a three‐in‐one single‐capsule formulation. Objective To evaluate the effectiveness and safety of the single‐capsule bismuth quadruple therapy. Methods Data were collected in a multicentre, prospective registry of the clinical practice of gastroenterologists on the management of H. pylori infection, where patients were registered at the Asociación Española de Gastroenterologia REDCap database on an electronic case report form until January 2020. Effectiveness by modified intention‐to‐treat and per‐protocol as well as multivariable analysis were performed. Independent factors evaluated were: age, gender, indication, compliance, proton pump inhibitor dose and treatment line. Results Finally, 2100 patients were prescribed single‐capsule bismuth quadruple therapy following the technical sheet (i.e., three capsules every 6 h for 10 days). The majority of these patients were naive (64%), with an average age of 50 years, 64% women and 16% with peptic ulcer. An overall modified intention‐to‐treat effectiveness of 92% was achieved. Eradication was over 90% in first‐line treatment (95% modified intention‐to‐treat, n = 1166), and this was maintained as a rescue therapy, both in second (89% modified intention‐to‐treat, n = 375) and subsequent lines of therapy (third to sixth line: 92% modified intention‐to‐treat, n = 236). Compliance was the factor most closely associated with treatment effectiveness. Adverse events were generally mild to moderate, and 3% of patients reported a severe adverse event, leading to discontinuation of treatment in 1.7% of cases. Conclusions Single‐capsule bismuth quadruple therapy achieved H. pylori eradication in approximately 90% of patients in real‐world clinical practice, both as a first‐line and rescue treatment, with good compliance and a favourable safety profile. The development of a three‐in‐one single‐capsule formulation has led to a resurgence in the use of bismuth quadruple therapy (BQT) to treat Helicobacter pylori infection. In the largest study carried out to date, the effectiveness of single‐capsule BQT was optimal both as a firstline and as a rescue therapy. Compliance was the factor most closely associated with treatment effectiveness. Single‐capsule BQT eradicates H. pylori in approximately 90% of patients in real‐world clinical practice, with a favourable safety profile.
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Affiliation(s)
- Olga P Nyssen
- Department of Gastroenterology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM) and Centro de Investigación Biomódica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Angeles Perez-Aisa
- Department of Gastroenterology, Agencia Sanitaria Costa del Sol, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Málaga, Spain
| | | | | | - Jose M Huguet
- Department of Gastroenterology, Hospital General Universitario de Valencia, Valencia, Spain
| | - Luis Rodrigo
- Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain
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- Department of Gastroenterology, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | | | - Ricardo M Pinto
- Department of Gastroenterology, Centro Hospitalar do Porto, Institute of Biomedical Sciences Abel Salazar, Porto, Portugal.,Department of Gastroenterology, Center for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
| | - Miguel Areia
- Department of Gastroenterology, Center for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal.,Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Monica Perona
- Department of Gastroenterology, Hospital Quiron, Marbella, Spain
| | - Oscar Nuñez
- Department of Gastroenterology, Hospital Universitario Sanitas La Moraleja, Madrid, Spain
| | - Marco Romano
- Department of Gastroenterology, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Antonietta G Gravina
- Department of Gastroenterology, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Liliana Pozzati
- Department of Gastroenterology, Hospital Mérida, Badajoz, Spain
| | | | - Marino Venerito
- Department of Gastroenterology, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - Peter Malfertheiner
- Department of Gastroenterology, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - Luis Fernanadez-Salazar
- Department of Gastroenterology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | | | - Dino Vaira
- Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - Ignasi Puig
- Althaia Xarxa Assistencial Universitària de Manresa and Universitat de Vic-Universitat Central de Catalunya (UVicUCC), Manresa, Spain
| | - Francis Megraud
- Laboratoire de Bacteriologie, Hôpital Pellegrin, Bordeaux Cedex, France
| | - Colm O'Morain
- Department of Gastroenterology, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Javier P Gisbert
- Department of Gastroenterology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM) and Centro de Investigación Biomódica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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31
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Nyssen OP, Bordin D, Tepes B, Pérez-Aisa Á, Vaira D, Caldas M, Bujanda L, Castro-Fernandez M, Lerang F, Leja M, Rodrigo L, Rokkas T, Kupcinskas L, Pérez-Lasala J, Jonaitis L, Shvets O, Gasbarrini A, Simsek H, Axon ATR, Buzás G, Machado JC, Niv Y, Boyanova L, Goldis A, Lamy V, Tonkic A, Przytulski K, Beglinger C, Venerito M, Bytzer P, Capelle L, Milosavljević T, Milivojevic V, Veijola L, Molina-Infante J, Vologzhanina L, Fadeenko G, Ariño I, Fiorini G, Garre A, Garrido J, F Pérez C, Puig I, Heluwaert F, Megraud F, O'Morain C, Gisbert JP. 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 2021; 70:40-54. [PMID: 32958544 DOI: 10.1136/gutjnl-2020-321372] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/08/2020] [Accepted: 06/26/2020] [Indexed: 12/18/2022]
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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Affiliation(s)
- Olga P Nyssen
- Gastroenterolgy Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Dmitry Bordin
- Department of Pancreatic, Biliary and Upper Digestive Tract Disorders, AS Loginov Moscow Clinical Scientific Center, Moscow, Russian Federation.,A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
| | - Bojan Tepes
- Gastroenterology, AM DC Rogaska, Rogaska Slatina, Slovenia
| | - Ángeles Pérez-Aisa
- Gastroenterology, Agencia Sanitaria Costa del Sol, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Marbella, Spain
| | - Dino Vaira
- Department of of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - Maria Caldas
- Gastroenterolgy Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Luis Bujanda
- Gastroenterology, Hospital Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), CIBEREHD, San Sebastian, Spain
| | | | - Frode Lerang
- Gastroenterololgy, Østfold Hospital Trust, Grålum, Norway
| | - Marcis Leja
- Digestive Diseases Centre GASTRO, Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Luís Rodrigo
- Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Limas Kupcinskas
- Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Laimas Jonaitis
- Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Oleg Shvets
- Internal Medicine, National Medical University named after O.O.Bogomolets, Kyiv, Ukraine
| | - Antonio Gasbarrini
- Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Halis Simsek
- Internal Medicine/Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - György Buzás
- Gastroenterology, Ferencváros Health Centre, Budapest, Hungary
| | - Jose Carlos Machado
- i3S - Instituto de Investigação e Inovação em Saúde. Medical Faculty of Porto. Universidade do Porto, Porto, Portugal
| | - Yaron Niv
- Gastroenterology, Rabin Medical Center, Tel Aviv University, Petah Tikva, Israel
| | | | - Adrian Goldis
- Gastroenterology, Timisoara Hospital, Timisoara, Romania
| | - Vincent Lamy
- Gastroenterology, Hepatology & Nutrition, CHU de Charleroi, Charleroi, Belgium
| | - Ante Tonkic
- Gastroenterology, University Hospital of Split, University of Split, Split, Croatia
| | | | | | - Marino Venerito
- Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
| | - Peter Bytzer
- Clinical Medicine, Zealand University Hospital, Copenhagen University, Copenhagen, Denmark
| | - Lisette Capelle
- Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, Netherlands
| | - Tomica Milosavljević
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia and School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladimir Milivojevic
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia and School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Lea Veijola
- Internal Medicine, Herttoniemi Hospital, Helsinki, Finland
| | | | | | - Galina Fadeenko
- Gastroenterology, Digestive Ukrainian Academy of Medical Sciences, Kyiv, Ukraine
| | - Ines Ariño
- Gastroenterology, Hospital Clinico Universitario Lozano Blesa, CIBEREHD, Zaragoza, Spain
| | - Giulia Fiorini
- Department of of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - Ana Garre
- Gastroenterolgy Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Jesús Garrido
- Departmento de Psicología Social y Metodología, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Cristina F Pérez
- Servicio de Medicina Preventiva, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ignasi Puig
- Gastroenterology, Althaia Xarxa Assistencial Universitària de Manresa and Universitat de Vic-Universitat Central de Catalunya (UVicUCC), Manresa, Spain
| | | | - Francis Megraud
- Laboratoire de Bactétiologie, Hôpital Pellegrin, Bordeaux, France
| | - Colm O'Morain
- Gastroenterology, Trinity College Dublin, Dublin, Ireland
| | - Javier P Gisbert
- Gastroenterolgy Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Madrid, Spain
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Gisbert JP. Rifabutin for the Treatment of Helicobacter Pylori Infection: A Review. Pathogens 2020; 10:pathogens10010015. [PMID: 33379336 PMCID: PMC7823349 DOI: 10.3390/pathogens10010015] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 12/17/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022] Open
Abstract
Nowadays, apart from having to know first-line Helicobacter pylori eradication regimens well, we must also be prepared to face treatment failures. The aim of this review is to summarize the role of rifabutin in the management of H. pylori infection. Bibliographical searches were performed in PubMed. Data on resistance and efficacy of rifabutin-containing regimens on H. pylori eradication were meta-analyzed. Mean H. pylori rifabutin resistance rate (39 studies, including 9721 patients) was 0.13%; when studies only including patients naïve to H. pylori eradication treatment were considered, this figure was even lower (0.07%). Mean H. pylori eradication rate (by intention-to-treat) with rifabutin-containing regimens (3052 patients) was 73%. Respective cure rates for second-, third-, fourth- and fifth-line therapies, were 79%, 69%, 69% and 72%. Most studies administered rifabutin 300 mg/day, which seemed to be more effective than 150 mg/day. The ideal length of treatment remains unclear, but 10–12-day regimens are generally recommended. Adverse events to rifabutin treatment in H. pylori studies were relatively infrequent (15%), and severe adverse events were exceptional (myelotoxicity was the most significant, although always reversible). In summary, rifabutin-containing therapy represents an encouraging strategy generally restricted, at present, to patients where previous (usually multiple) eradication regimens have failed.
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Affiliation(s)
- Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28006 Madrid, Spain
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33
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European Registry on Helicobacter pylori Management: Effectiveness of First and Second-Line Treatment in Spain. Antibiotics (Basel) 2020; 10:antibiotics10010013. [PMID: 33375717 PMCID: PMC7823881 DOI: 10.3390/antibiotics10010013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 01/10/2023] Open
Abstract
The management of Helicobacter pylori infection has to rely on previous local effectiveness due to the geographical variability of antibiotic resistance. The aim of this study was to evaluate the effectiveness of first and second-line H. pylori treatment in Spain, where the empirical prescription is recommended. A multicentre prospective non-interventional registry of the clinical practice of European gastroenterologists concerning H. pylori infection (Hp-EuReg) was developed, including patients from 2013 until June 2019. Effectiveness was evaluated descriptively and through a multivariate analysis concerning age, gender, presence of ulcer, proton-pump inhibitor (PPI) dose, therapy duration and compliance. Overall, 53 Spanish hospitals were included, and 10,267 patients received a first-line therapy. The best results were obtained with the 10-day bismuth single-capsule therapy (95% cure rate by intention-to-treat) and with both the 14-day bismuth-clarithromycin quadruple (PPI-bismuth-clarithromycin-amoxicillin, 91%) and the 14-day non-bismuth quadruple concomitant (PPI-clarithromycin-amoxicillin-metronidazole, 92%) therapies. Second-line therapies were prescribed to 2448 patients, with most-effective therapies being the triple quinolone (PPI-amoxicillin-levofloxacin/moxifloxacin) and the bismuth-levofloxacin quadruple schemes (PPI-bismuth-levofloxacin-amoxicillin) prescribed for 14 days (92%, 89% and 90% effectiveness, respectively), and the bismuth single-capsule (10 days, 88.5%). Compliance, longer duration and higher acid inhibition were associated with higher effectiveness. “Optimized” H. pylori therapies achieve over 90% success in Spain.
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Abstract
The main challenge in the field of Helicobacter pylori (H. pylori) infection is antibiotic resistance, which influences the efficacy of eradication regimens. Bismuth-containing quadruple therapy has been confirmed as an effective regimen for eradicating H. pylori, especially in strains with antibiotic resistance. High-dose proton-pump inhibitor-amoxicillin dual therapy could decrease the use of unnecessary antibiotics, which is a promising alternative approach. Adjuvant therapy (specific probiotic or vitamin) also showed good results, although more evidence is needed. Novel anti-H. pylori drugs are needed, and the establishment of the H. pylori database is an effective way to acknowledge the real-time information of H. pylori management. This review provides the recent progress of H. pylori treatment, and further studies are needed to address the role of different regimens in improving H. pylori eradication rate, especially in strains with antibiotics resistance.
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Affiliation(s)
- Yi Hu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
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35
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Gisbert JP. Empirical or susceptibility-guided treatment for Helicobacter pylori infection? A comprehensive review. Therap Adv Gastroenterol 2020; 13:1756284820968736. [PMID: 33240392 PMCID: PMC7675893 DOI: 10.1177/1756284820968736] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/01/2020] [Indexed: 02/06/2023] Open
Abstract
Although susceptibility-guided therapy is frequently recommended for Helicobacter pylori infection, the evidence available to date supporting this strategy is limited. The aim of the present article is to review the advantages and limitations of the susceptibility-guided and the empirical strategies to treat this infection. We performed a bibliographic search to identify studies investigating H. pylori susceptibility-guided therapy. Culture is not the only way to assess antibiotic resistance, as different polymerase chain reaction-based approaches have been developed as alternative methods. For detecting H. pylori antimicrobial resistance, a molecular approach based on a stool sample might enable more convenient, time-saving methods. Unfortunately, the antimicrobial susceptibility cannot be obtained in all cases. Furthermore, antibiotic susceptibility testing in clinical practice yields useful information only for a few antibiotics: clarithromycin, metronidazole, and quinolones. In addition, susceptibility towards clarithromycin and metronidazole in vitro does not necessarily lead to eradication in vivo. In the case of H. pylori therapy failure, we should not re-administer any of the antibiotics against which H. pylori has probably become resistant. Our updated meta-analysis showed that susceptibility-guided treatment is not better than empirical treatment of H. pylori infection in first-line therapy if the most updated quadruple regimens are empirically prescribed, and similar efficacy results were also demonstrated with the two strategies for second-line therapy. Cumulative H. pylori eradication rate with several successive rescue therapies empirically prescribed reaches almost 100%. Finally, the studies that have evaluated the cost-effectiveness of the susceptibility-guided treatment have achieved contradictory results. In summary, we can conclude that the evidence is too limited to support the generalized use of susceptibility-guided therapy for H. pylori treatment in routine clinical practice, either as first-line or as rescue treatment. Nevertheless, it would be recommended that susceptibility tests are performed routinely, even before prescribing first-line treatment, in specialized centers with an interest in H. pylori management.
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Affiliation(s)
- Javier P. Gisbert
- Gastroenterology Unit, Hospital Universitario de La
Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad
Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades
Hepáticas y Digestivas (CIBEREHD), Diego de León, 62, Madrid, 28006, Spain
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Gisbert JP. Optimization Strategies Aimed to Increase the Efficacy of Helicobacter pylori Eradication Therapies with Quinolones. Molecules 2020; 25:E5084. [PMID: 33147814 PMCID: PMC7663000 DOI: 10.3390/molecules25215084] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 12/14/2022] Open
Abstract
H. pylori infection is the main cause of gastritis, gastroduodenal ulcer disease, and gastric cancer. Fluoroquinolones such as levofloxacin, or more recently moxifloxacin or sitafloxacin, are efficacious alternatives to standard antibiotics for H. pylori eradication. The aim of the present review is to summarize the role of quinolone-based eradication therapies, mainly focusing on the optimization strategies aimed to increase their efficacy. Several meta-analyses have shown that, after failure of a first-line eradication treatment, a levofloxacin-containing rescue regimen is at least equally effective, and better tolerated, than the generally recommended bismuth quadruple regimen. Compliance with the levofloxacin regimens is excellent, and the safety profile is favourable. Higher cure rates have been reported with longer treatments (>10-14 days), and 500 mg levofloxacin daily is the recommended dose. Adding bismuth to the standard triple regimen (PPI-amoxicillin-levofloxacin) has been associated with encouraging results. Unfortunately, resistance to quinolones is easily acquired and is increasing in most countries, being associated with a decrease in the eradication rate of H. pylori. In summary, a quinolone (mainly levofloxacin)-containing regimen is an encouraging second-line (or even third-line) strategy, and a safe and simple alternative to bismuth quadruple therapy in patients whose previous H. pylori eradication therapy has failed.
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Affiliation(s)
- Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28006 Madrid, Spain
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Management of Helicobacter pylori. Curr Opin Gastroenterol 2020; 36:518-524. [PMID: 32868505 DOI: 10.1097/mog.0000000000000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW Gastroenterologists and many general internists and primary care physicians confront questions regarding the management of Helicobacter pylori on a daily basis. The subject remains of global interest and continue to generate debate and research. Using the search terms 'pylori and treatment' or 'pylori and management' we identified over 1000 relevant articles in PubMed published over the time period 1 January 2019 to 30 April 2020. We have selected the most highly clinically relevant of these to review here. RECENT FINDINGS Clinical evidence grows regarding the benefits of H. pylori eradication on gastric cancer prevention. High rates of resistance to clarithromycin and levofloxacin, correlating with treatment failure in regimens utilizing these drugs, has stimulated interest in alternative regimens as well as the need for susceptibility testing of individual patients and populations. Although many aspects of H. pylori management are well established, implementation of appropriate testing and treatment pathways remains suboptimal throughout healthcare settings. SUMMARY Increased emphasis on measuring H. pylori-related clinical outcomes in practice is needed to identify implementation gaps, and to suggest means to best apply the knowledge gained on H. pylori for the prevention of gastric symptoms and disease.
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Nyssen OP, Perez-Aisa A, Rodrigo L, Castro M, Mata Romero P, Ortuño J, Barrio J, Huguet JM, Modollel I, Alcaide N, Lucendo A, Calvet X, Perona M, Gomez B, Gomez Rodriguez BJ, Varela P, Jimenez-Moreno M, Dominguez-Cajal M, Pozzati L, Burgos D, Bujanda L, Hinojosa J, Molina-Infante J, Di Maira T, Ferrer L, Fernández-Salazar L, Figuerola A, Tito L, de la Coba C, Gomez-Camarero J, Fernandez N, Caldas M, Garre A, Resina E, Puig I, O'Morain C, Megraud F, Gisbert JP. Bismuth quadruple regimen with tetracycline or doxycycline versus three-in-one single capsule as third-line rescue therapy for Helicobacter pylori infection: Spanish data of the European Helicobacter pylori Registry (Hp-EuReg). Helicobacter 2020; 25:e12722. [PMID: 32656898 DOI: 10.1111/hel.12722] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Different bismuth quadruple therapies containing proton-pump inhibitors, bismuth salts, metronidazole, and a tetracycline have been recommended as third-line Helicobacter pylori eradication treatment after failure with clarithromycin and levofloxacin. AIM To evaluate the efficacy and safety of third-line treatments with bismuth, metronidazole, and either tetracycline or doxycycline. METHODS Sub-study with Spanish data of the "European Registry on H pylori Management" (Hp-EuReg), international multicenter prospective non-interventional Registry of the routine clinical practice of gastroenterologists. After previous failure with clarithromycin- and levofloxacin-containing therapies, patients receiving a third-line regimen with 10/14-day bismuth salts, metronidazole, and either tetracycline (BQT-Tet) or doxycycline (BQT-Dox), or single capsule (BQT-three-in-one) were included. Data were registered at AEG-REDCap database. Univariate and multivariate analyses were performed. RESULTS Four-hundred and fifty-four patients have been treated so far: 85 with BQT-Tet, 94 with BQT-Dox, and 275 with BQT-three-in-one. Average age was 53 years, 68% were women. Overall modified intention-to-treat and per-protocol eradication rates were 81% (BQT-Dox: 65%, BQT-Tet: 76%, BQT-three-in-one: 88%) and 82% (BQT-Dox: 66%, BQT-Tet: 77%, BQT-three-in-one: 88%), respectively. By logistic regression, higher eradication rates were associated with compliance (OR = 2.96; 95% CI = 1.01-8.84) and no prior metronidazole use (OR = 1.96; 95% CI = 1.15-3.33); BQT-three-in-one was superior to BQT-Dox (OR = 4.46; 95% CI = 2.51-8.27), and BQT-Tet was marginally superior to BQT-Dox (OR = 1.67; 95% CI = 0.85-3.29). CONCLUSION Third-line H pylori eradication with bismuth quadruple treatment (after failure with clarithromycin and levofloxacin) offers acceptable efficacy and safety. Highest efficacy was found in compliant patients and those taking 10-day BQT-three-in-one or 14-day BQT-Tet. Doxycycline seems to be less effective and therefore should not be recommended.
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Affiliation(s)
- Olga P Nyssen
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | | | - Luis Rodrigo
- Gastroenterology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Manuel Castro
- Gastroenterology Unit, Hospital de Valme and CIBEREHD, Sevilla, Spain
| | - Pilar Mata Romero
- Gastroenterology Unit, Hospital San Pedro de Alcántara and CIBEREHD, Cáceres, Spain
| | - Juan Ortuño
- Gastroenterology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Jesus Barrio
- Gastroenterology Unit, Hospital Rio Hortega, Valladolid, Spain
| | - Jose Maria Huguet
- Gastroenterology Unit, Consorci Hospital General Universitari Valencia, Valencia, Spain
| | - Ines Modollel
- Gastroenterology Unit, Consorci Sanitari Terrassa, Terrassa, Spain
| | - Noelia Alcaide
- Gastroenterology Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Alfredo Lucendo
- Gastroenterology Unit, Hospital de Tomelloso, Ciudad Real, Spain
| | - Xavier Calvet
- Gastroenterology Unit, Hospital de Sabadell and CIBEREHD, Barcelona, Spain
| | - Monica Perona
- Gastroenterology Unit, Hospital Quiron, Marbella, Spain
| | - Barbara Gomez
- Gastroenterology Unit, Hospital de Mataró, Barcelona, Spain
| | | | - Pilar Varela
- Gastroenterology Unit, Hospital de Cabueñes Gijon, Spain
| | | | | | | | - Diego Burgos
- Gastroenterology Unit, Hospital Ramon y Cajal, Madrid, Spain
| | - Luis Bujanda
- Gastroenterology Unit, Hospital Donostia/Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | - Jenifer Hinojosa
- Gastroenterology Unit, Agencia Sanitaria Costa del Sol, Málaga, Spain
| | | | - Tommaso Di Maira
- Gastroenterology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Luis Ferrer
- Gastroenterology Unit, Consorci Hospital General Universitari Valencia, Valencia, Spain
| | | | - Ariadna Figuerola
- Gastroenterology Unit, Hospital de Sabadell and CIBEREHD, Barcelona, Spain
| | - Llucia Tito
- Gastroenterology Unit, Hospital de Mataró, Barcelona, Spain
| | | | | | - Nuria Fernandez
- Gastroenterology Unit, Agencia Sanitaria Costa del Sol, Málaga, Spain
| | - Maria Caldas
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Ana Garre
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Elena Resina
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Ignasi Puig
- Gastroenterology Unit, Althaia Xarxa Assistencial Universitària de Manresa and Universitat de Vic-Universitat Central de Catalunya (UVicUCC), Manresa, Spain
| | - Colm O'Morain
- Gastroenterology Unit, Trinity College, Dublin, Ireland
| | - Francis Megraud
- Gastroenterology Unit, Centre National de Référence des Campylobacters et Hélicobacters, Université de Bordeaux, Bordeaux, France
| | - Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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Abdulkhakov SR, Bordin DS, Abdulkhakov RA, Safina DD, Gizdatullina AR, Gimadieva LZ, Safina GM, Ziyatdinov AI, Maturina AM, Nyssen OP, Megraud F, O'Morain C, Perez-Gisbert J. [European Registry on the management of Helicobacter pylori infection: features of diagnosis and treatment in Kazan]. TERAPEVT ARKH 2020; 92:52-59. [PMID: 33346462 DOI: 10.26442/00403660.2020.08.000758] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND As part of an observational multicenter prospective study European Registry on the management of Helicobacter pylori infection, conducted on the initiative of the European H. pylori and Microbiota Study Group, the compliance of clinical practice in the management of patients with Helicobacter pylori infection in Kazan with clinical guidelines was assessed. MATERIALS AND METHODS The data of 437 patients included into the register by clinical sites in Kazan in 20132019 were analyzed. The methods used for the initial diagnosis of H. pylori infection and eradication control were evaluated. The frequency of various eradication therapy regimens prescription was analyzed in 379 cases. Data regarding the effectiveness of eradication therapy was analyzed in 173 patients. RESULTS The rapid urease test (44.2% of cases) and cytology/histology (60% of cases) were most often used for the initial diagnosis of H. pylori infection; however non-invasive methods such as 13C-urea breath (9.2%), serology (6.2%), H. pylori stool antigen test (2.3%) were less common. In 21.7% of patients two methods of H. pylori detection were used for primary diagnosis. The control test to evaluate the effectiveness of eradication therapy at the recommended timepoint was performed in 46.2% of patients. 13C-urea breath test (31.7%), stool PCR/stool antigen test (28.7%), rapid urease test (22.3%), cytology/histology (26.2% of cases) prevailed in the assessment of eradication rate. Standard triple therapy, including proton pump inhibitor, clarithromycin and amoxicillin was most commonly prescribed as first-line therapy (64.6% of cases). The duration of eradication therapy was 14 days in the majority of cases with pantoprazole as the most common proton pump inhibitor in standard triple therapy regimens (84.8%). The efficacy of 14-day standard triple therapy (mITT) was 87.0%. CONCLUSION The results indicate a high frequency of non-invasive methods use for assessing the effectiveness of eradication therapy; however, the overall rate of eradication efficacy assessment is low, limiting the possibility of analyzing the eradication results. The effectiveness of the most common 14-day standard triple first-line therapy in Kazan doesnt reach the recommended 90% eradication level. This could be explained by high rate of pantoprazole use, which is not an optimal proton pump inhibitor in eradication therapy regimens.
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Affiliation(s)
| | - D S Bordin
- Loginov Moscow Clinical Scientific and Practical Center.,Tver State Medical University.,Yevdokimov Moscow State University of Medicine and Dentistry
| | | | | | | | | | | | | | | | - O P Nyssen
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), and Universidad Autónoma de Madrid (UAM)
| | - F Megraud
- Laboratoire de Bactériologie, Hôpital Pellegrin
| | - C O'Morain
- Trinity College Dublin - Faculty of Health Sciences, Trinity College Dublin.,Dublin/IE, Faculty of Health Sciences
| | - J Perez-Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), and Universidad Autónoma de Madrid (UAM)
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O'Connor A, Furuta T, Gisbert JP, O'Morain C. Review - Treatment of Helicobacter pylori infection 2020. Helicobacter 2020; 25 Suppl 1:e12743. [PMID: 32918350 DOI: 10.1111/hel.12743] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This review summarizes important studies regarding Helicobacter pylori therapy published from April 2019 to April 2020. The main themes that emerge involve studies assessing antibiotic resistance, and there is also growing momentum behind the utility of vonoprazan as an alternative to proton pump inhibitor (PPI) therapy and also bismuth-based regimens as a first-line regimen. Antibiotic resistance is rising wherever it is being assessed, and clarithromycin resistance in particular has reached a point where it may no longer be a viable therapy without previous testing in many regions of the world. The evidence for the efficacy of a bismuth-based quadruple therapy as a first-line therapy is now very clearly established, and there is substantial evidence that it is the best performing first-line therapy. The utility of vonoprazan as an alternative to PPI therapy, especially in resistant and difficult-to-treat groups, has also been considered in great detail this year, and it may offer an opportunity in the near future to reduce the problem of antibiotic resistance.
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Affiliation(s)
- Anthony O'Connor
- Department of Gastroenterology, Tallaght University Hospital/Trinity College, Dublin, Ireland
| | - Takahisa Furuta
- The Center for Clinical Research, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Colm O'Morain
- Department of Gastroenterology, Tallaght University Hospital/Trinity College, Dublin, Ireland
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Beresniak A, Malfertheiner P, Franceschi F, Liebaert F, Salhi H, Gisbert JP. Helicobacter pylori "Test-and-Treat" strategy with urea breath test: A cost-effective strategy for the management of dyspepsia and the prevention of ulcer and gastric cancer in Spain-Results of the Hp-Breath initiative. Helicobacter 2020; 25:e12693. [PMID: 32285569 DOI: 10.1111/hel.12693] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Data from clinical trials comparing Helicobacter pylori (H. pylori) management strategies in patients with dyspepsia are limited. Cost-effectiveness simulation models might help to identify the optimal strategy. OBJECTIVE To assess the cost-effectiveness of the H. pylori "Test and Treat" (T&T) strategy including the use of urea breath test (UBT) vs symptomatic treatment (ST) and vs upper gastrointestinal endoscopy (UGE) as a first procedure in patients with dyspepsia. METHODS Three main strategies: "T&T" strategy including the use of UBT, "UGE" and "ST" have been compared using cost-effectiveness models developed in accordance with the Spanish medical practice. For the model simulations, a time horizon of 4 weeks was considered for the endpoint "Dyspepsia symptoms relief" and 10 years when using "Peptic ulcer avoided" and "Gastric cancer avoided" endpoints. RESULTS For the endpoint "Dyspepsia symptoms relief", T&T strategy appears to be the most cost-effective (883€/success) compared to UGE strategy and to ST strategy (respectively 1628€ and 990€/success). For the endpoint "Probability of peptic ulcer", the T&T strategy appears to be the most cost-effective (421€/peptic ulcer avoided/y) compared to UGE strategy and ST strategy (respectively 728€ and 632€/peptic ulcer avoided/y). For the endpoint "Gastric cancer avoided", the T&T strategy appears to be the most cost-effective (524€/gastric cancer avoided/y) compared to UGE strategy and "ST" strategy (respectively 716€ and 696€/gastric cancer avoided/y). CONCLUSIONS T&T strategy including the use of UBT is the most cost-effective medical approach for management of dyspepsia and for the prevention of ulcer and gastric cancer.
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Affiliation(s)
| | - Peter Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany.,Department of Medicine II, University Hospital, LMU, Munich, Germany
| | - Francesco Franceschi
- Department of Gastroenterology and Internal Medicine, Catholic University, Rome, Italy
| | | | | | - Javier P Gisbert
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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Nyssen OP, Pérez-Aisa Á, Tepes B, Rodrigo-Sáez L, Romero PM, Lucendo A, Castro-Fernández M, Phull P, Barrio J, Bujanda L, Ortuño J, Areia M, Brglez Jurecic N, Huguet JM, Alcaide N, Voynovan I, María Botargues Bote J, Modolell I, Pérez Lasala J, Ariño I, Jonaitis L, Dominguez-Cajal M, Buzas G, Lerang F, Perona M, Bordin D, Axon T, Gasbarrini A, Marcos Pinto R, Niv Y, Kupcinskas L, Tonkic A, Leja M, Rokkas T, Boyanova L, Shvets O, Venerito M, Bytzer P, Goldis A, Simsek I, Lamy V, Przytulski K, Kunovský L, Capelle L, Milosavljevic T, Caldas M, Garre A, Mégraud F, O'Morain C, Gisbert JP. Helicobacter pylori first-line and rescue treatments in patients allergic to penicillin: Experience from the European Registry on H pylori management (Hp-EuReg). Helicobacter 2020; 25:e12686. [PMID: 32173974 DOI: 10.1111/hel.12686] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Experience in Helicobacter pylori eradication treatment of patients allergic to penicillin is very scarce. A triple combination with a PPI, clarithromycin (C), and metronidazole (M) is often prescribed as the first option, although more recently the use of a quadruple therapy with PPI, bismuth (B), tetracycline (T), and M has been recommended. AIM To evaluate the efficacy and safety of first-line and rescue treatments in patients allergic to penicillin in the "European Registry of H pylori management" (Hp-EuReg). METHODS A systematic prospective registry of the clinical practice of European gastroenterologists (27 countries, 300 investigators) on the management of H pylori infection. An e-CRF was created on AEG-REDCap. Patients with penicillin allergy were analyzed until June 2019. RESULTS One-thousand eighty-four patients allergic to penicillin were analyzed. The most frequently prescribed first-line treatments were as follows: PPI + C + M (n = 285) and PPI + B + T + M (classic or Pylera® ; n = 250). In first line, the efficacy of PPI + C + M was 69%, while PPI + B + T + M reached 91% (P < .001). In second line, after the failure of PPI + C + M, two rescue options showed similar efficacy: PPI + B + T + M (78%) and PPI + C + levofloxacin (L) (71%) (P > .05). In third line, after the failure of PPI + C + M and PPI + C + L, PPI + B + T + M was successful in 75% of cases. CONCLUSION In patients allergic to penicillin, a triple combination with PPI + C + M should not be generally recommended as a first-line treatment, while a quadruple regimen with PPI + B + T + M seems to be a better option. As a rescue treatment, this quadruple regimen (if not previously prescribed) or a triple regimen with PPI + C + L could be used but achieved suboptimal (<80%) results.
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Affiliation(s)
- Olga P Nyssen
- Gastroenterology Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ángeles Pérez-Aisa
- Digestive Unit, Agencia Sanitaria Costa del Sol, Marbella, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Málaga, Spain
| | - Bojan Tepes
- Gastroenterology Unit, AM DC Rogaska, Rogaska Slatina, Slovenia
| | - Luis Rodrigo-Sáez
- Gastroenterology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | | | | | - Luis Bujanda
- Department of Gastroenterology, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), Donosti, Spain
| | - Juan Ortuño
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel Areia
- Portuguese Oncology Institute, Coimbra, Portugal
| | | | | | - Noelia Alcaide
- Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Irina Voynovan
- Department of Pancreatobiliary and Upper GI Diseases, Moscow Clinical Scientific Center, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | | | | | | | - Inés Ariño
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Laimas Jonaitis
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - György Buzas
- Gastroenterology Unit, Ferencváros Policlinic, Budapest, Hungary
| | - Frode Lerang
- Medical Department, Central Hospital Ostfold, Fredrikstad, Norway
| | | | - Dmitry Bordin
- Department of Pancreatobiliary and Upper GI Diseases, Moscow Clinical Scientific Center, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Toni Axon
- Gastroenterology Unit, University of Leeds, Leeds, UK
| | - Antonio Gasbarrini
- Gastronterology Area, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Ricardo Marcos Pinto
- Centro Hospitalar do Porto, Institute of Biomedical Sciences Abel Salazar, University of Porto and CINTESIS, University of Porto, Porto, Portugal
| | - Yaron Niv
- Department of Gastroenterology, Rabin Medical Center, Tel Aviv University, Petach Tikva, Israel
| | - Limas Kupcinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ante Tonkic
- Department of Gastroenterology, School of Medicine, University Hospital of Split, University of Split, Split, Croatia
| | - Marcis Leja
- Faculty of Medicine, Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
| | - Theodore Rokkas
- Gastroenterology Unit, Henry Dunant Hospital, Athens, Greece
| | - Lyudmila Boyanova
- Department of Medical Microbiology, Medical University of Sofia, Sofia, Bulgaria
| | - Oleg Shvets
- Internal Diseases Department No. 1, National Medical University named after O.O. Bogomolets, Kyiv, Ukraine
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - Peter Bytzer
- Department of Medicine, Zealand University Hospital, Copenhagen University, Copenhagen, Denmark
| | - Adrian Goldis
- Gastroenterology Unit, Timisoara Hospital, Timisoara, Romania
| | - Ilkay Simsek
- Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Vincent Lamy
- Department of Gastroenterology, Hepatology & Nutrition, CHU Charleroi, Charleroi, Belgium
| | - Krzysztof Przytulski
- Gastroenterology Unit, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - Lumír Kunovský
- Department of Gastroenterology and Internal Medicine and Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lisette Capelle
- Gastroenterology and Hepatology, Erasmus MC University, Rotterdam, The Netherlands
| | - Tomica Milosavljevic
- Medical Department, Clinical Center of Serbia Clinic for Gastroenterology and Hepatology, University of Belgrade, Belgrade, Serbia
| | - María Caldas
- Gastroenterology Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ana Garre
- Gastroenterology Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Francis Mégraud
- Laboratoire de Bactériologie, Hôpital Pellegrin, Bordeaux Cedex, France
| | - Colm O'Morain
- Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Javier P Gisbert
- Gastroenterology Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
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Bordin DS, Voynovan IN, Embutnieks YV, Nyssen OP, Megraud F, O`Morain C, Perez-Gisbert J. European registry on Helicobacter pylori management (Hp-EuReg) as a tool to evaluate and improve clinical practice in Moscow. TERAPEVT ARKH 2020; 92:12-18. [PMID: 32598712 DOI: 10.26442/00403660.2020.02.000567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Indexed: 12/20/2022]
Abstract
Continuous evaluation of the actual clinical practice of diagnosis and treatment of Helicobacter pylori is crucial in order to provide the best standard of care and to compare health outcomes with expert recommendations.
Aim:to evaluate the effectiveness of the standard triple therapy (amoxicillin, clarithromycin, a proton pump inhibitor) and the standard triple therapy plus bismuth tripotassium dicitrate.
Materials and methods.Observational, prospective, multicenter study, carried out in one single Russian centre A.S. Loginov Moscow Clinical Scientific Center as part of the Hp-EuReg. Patients were included from 2013 to November 2019 by Russian gastroenterologists.
Results.A total of 647 patients were collected and 330 were administered either standard triple therapy ((amoxicillin, clarithromycin, a proton pump inhibitor) or standard triple therapy plus bismuth tripotassium dicitrate. Invasive methods is dominates in the initial diagnosis of H. pylori: the frequency of use of the quick urease test decreased from 50% in 2013 to 31% in 2019. Serology was used in 27.9%. There has been an increase in the use of the13C-urea breath test from 13% in 2013 to 31% in 2019. The histological method (7.5%) and the stool antigen test (3.2%) were used less frequently. For eradication control non-invasive methods are mostly used:13C-UDT (82.7%) and the stool antigen test (14.4%). The effectiveness of standard triple therapy (mITT) was 68% with a 7-day course, 79% with a 10-day course, and 70% with a 14-day course. Combination of bismuth and standard triple therapy eradicates H. pylori (mITT) in 63%, 75% and 89%, respectively.
Conclusion.An improvement in the clinical practice of managing patients with H. pylori infections has been noted. The standard triple therapy in combination with bismuth tripotassium dicitrate, prescribed for 14 days, is more effective.
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O'Connor A, Liou JM, Gisbert JP, O'Morain C. Review: Treatment of Helicobacter pylori Infection 2019. Helicobacter 2019; 24 Suppl 1:e12640. [PMID: 31486235 DOI: 10.1111/hel.12640] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2019] [Indexed: 02/06/2023]
Abstract
This review summarizes important studies regarding Helicobacter pylori therapy published from May 2018 to May 2019. The main themes that emerge involve studies assessing the efficacy of bismuth-based regimens. While in recent years the efficacy of bismuth-based quadruple therapy as a second-line therapy has been clearly established, there is now substantial evidence that it is the best performing first-line therapy. Antibiotic resistance was again intensely studied this year, and a clear and dramatic increase in resistance is noted for clarithromycin and levofloxacin; most notably, it may not be possible to support these therapies in most regions of the world much longer without testing. The utility of vonoprazan as an alternative to proton-pump inhibitor therapy, especially in resistant and difficult to treat groups, has also been considered in greater detail this year, as well as means of supporting and enhancing adherence to therapy. Several studies showed that the diversity of gut microbiota was significantly altered shortly after H pylori eradication. However, the diversity was restored to pre-treatment state after 2 months in patients treated with triple therapy. More studies are warranted to assess the long-term changes of gut microbiota after H pylori eradication.
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Affiliation(s)
- Anthony O'Connor
- Department Of Gastroenterology, Tallaght University Hospital/Trinity College, Dublin, Ireland
| | - Jyh-Ming Liou
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Javier P Gisbert
- Gastroenterology Unit, Instituto de Investigación Sanitaria Princesa (IIS-IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Universitario de La Princesa, Madrid, Spain
| | - Colm O'Morain
- Department Of Gastroenterology, Tallaght University Hospital/Trinity College, Dublin, Ireland
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Boyanova L, Hadzhiyski P, Kandilarov N, Markovska R, Mitov I. Multidrug resistance in Helicobacter pylori: current state and future directions. Expert Rev Clin Pharmacol 2019; 12:909-915. [PMID: 31424296 DOI: 10.1080/17512433.2019.1654858] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Helicobacter pylori antibiotic resistance has increased worldwide and multidrug resistance (MDR), which seriously hampers eradication success of the frequent chronic infection, has often been reported. Areas covered: H. pylori MDR rates are discussed, mostly from recent articles published since 2015. Present approaches and future directions to counteract the MDR are outlined. Expert opinion: Alarming presence of triple, quadruple and, in some studies, quintuple and sextuple resistance was detected. Primary MDR rates ranged from <10% in most European countries to >40% in Peru. Post-treatment or overall MDR rates were >23-36% in about half of the studies. MDR prevalence has varied both among and within the countries. Factors linked to the MDR are national antibiotic consumption, antibiotic misuse, treatment failures and bacterial factors such as mutations, efflux pumps, and biofilms. Important directions to counteract the MDR increase can be optimization of present and new eradication regimens, wider use of bismuth-containing regimens, assessment of benefit of vonoprazan, new antibiotics such as newer fluoroquinolones and oxazolidinone analogues, adjuvants involving N-acetylcysteine and probiotics, anti-biofilm approaches using anti-biofilm peptides and rhamnolipid and development of vaccines and non-invasive tests for resistance detection. However, more efforts and studies are required. Strain susceptibility testing is increasingly important.
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Affiliation(s)
- Lyudmila Boyanova
- Department of Medical Microbiology, Medical University of Sofia , Sofia , Bulgaria
| | - Petyo Hadzhiyski
- Specialized Hospital for Active Pediatric Treatment, Medical University of Sofia , Sofia , Bulgaria
| | - Nayden Kandilarov
- Department of General and Hepatobiliary Pancreatic Surgery, Department of Surgery, Medical University , Sofia , Bulgaria
| | - Rumyana Markovska
- Department of Medical Microbiology, Medical University of Sofia , Sofia , Bulgaria
| | - Ivan Mitov
- Department of Medical Microbiology, Medical University of Sofia , Sofia , Bulgaria
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