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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] [What about the content of this article? (0)] [Affiliation(s)] [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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