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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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4
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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McNicholl AG, Garre A, Llorca L, Bujanda L, Molina-Infante J, Barenys M, Perez J, Guerrero-Torres MD, Tamayo E, Montes M, Prados-Manzano R, Sanchez-Garcia A, Ramas M, Valdez Blanco VB, Montoro M, Calvet X, Figuerola A, Lario S, Quilez E, Lanas A, Silva-Pomarino P, Perez-Aisa A, Donday MG, Belloc B, Montserrat-Torres A, Fernandez-Moreno N, Ramírez MJ, Alarcon T, Gisbert JP. Prospective, study comparing the accuracy of two different stool antigen tests (Premier Platinum HpSA and novel ImmunoCard STAT! rapid test) for the diagnosis of Helicobacter pylori infection. Gastroenterol Hepatol 2019; 43:117-125. [PMID: 31810793 DOI: 10.1016/j.gastrohep.2019.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/16/2019] [Accepted: 09/25/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND At present only monoclonal EIA (enzyme-immunoassay) stool antigen-tests have obtained optimal accuracy in the diagnosis of Helicobacter pylori. Our aim was to evaluate the accuracy of two stool antigen-tests, the validated Premier Platinum HpSA PLUS (EIA test) and the newly available ImmunoCard STAT! HpSA HD (rapid test) for the initial diagnosis and the confirmation of eradication of H. pylori infection. PATIENTS AND METHODS Patients with indication of H. pylori diagnosis, or confirmation after treatment were included. Data were coded to protect personal data and ensure blindness between tests. Accuracy was considered as coincident diagnosis with the gold standard (13C-urea breath test, UBT). The EIA was used as a bench standard. All stool tests were performed in duplicate. RESULTS 264 patients completed the protocol (100 naïve, 164 post-eradication). Average age was 52 years, 61% women, 11% ulcer. Positive diagnoses by UBT were 41% for naïve and 17% for post-eradication. Overall ImmunoCard and EIA accuracies were respectively 91% (95%C.I.=88-94%) and 89% (86-93%), sensitivities 72% (67-78%) and 72% (67-78%), and specificities 98% (96-100%), and 95% (92-97%). Concordance between ImmunoCard and EIA was 95% (93-98%). DISCUSSION Our results indicate that the newly available ImmunoCard rapid stool antigen-test achieves 90% accuracy, with high specificity but suboptimal sensitivity. The ImmunoCard attained equivalent accuracies as the EIA bench standard, with 95% concordance.
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Affiliation(s)
- Adrian G McNicholl
- Gastroenterology Unit, La Princesa University Hospital, 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
| | - Ana Garre
- Gastroenterology Unit, La Princesa University Hospital, 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
| | - Laura Llorca
- Microbiology Service, La Princesa University Hospital and Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Luis Bujanda
- Digestive Service, Donostia University Hospital and Instituto Biodonostia, Universidad del País Vasco UPV/EHU and CIBERehd, San Sebastián, Spain
| | | | - Merce Barenys
- Digestive Service, Viladecans Hospital, Barcelona, Spain
| | - Julia Perez
- Gastroenterology Unit, La Princesa University Hospital, 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
| | - Maria D Guerrero-Torres
- Microbiology Service, La Princesa University Hospital and Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Esther Tamayo
- Microbiology Service, Donostia University Hospital and Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), San Sebastián, Spain
| | - Milagrosa Montes
- Microbiology Service, Donostia University Hospital and Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), San Sebastián, Spain
| | - Raul Prados-Manzano
- Digestive Service, San Pedro de Alcántara Hospital, and CIBERehd, Cáceres, Spain
| | | | - Mercedes Ramas
- Gastroenterology Unit, La Princesa University Hospital, 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
| | - Veronica B Valdez Blanco
- Microbiology Service, La Princesa University Hospital and Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | | | - Xavier Calvet
- Digestive Service, Hospital Universitari Parc Taulí, and CIBERehd, Sabadell, Spain
| | - Ariadna Figuerola
- Digestive Service, Hospital Universitari Parc Taulí, and CIBERehd, Sabadell, Spain
| | - Sergio Lario
- Digestive Service, Hospital Universitari Parc Taulí, and CIBERehd, Sabadell, Spain
| | - Eia Quilez
- Digestive Service, Hospital Universitari Parc Taulí, and CIBERehd, Sabadell, Spain
| | - Angel Lanas
- Digestive Service, Lozano Blesa Hospital, and CIBERehd, Zaragoza, Spain
| | | | - Angeles Perez-Aisa
- Digestive Service, Agencia Sanitaria Costa del Sol Hospital, Málaga, Spain
| | - Maria G Donday
- Gastroenterology Unit, La Princesa University Hospital, 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
| | - Blanca Belloc
- Digestive Service, San Jorge Hospital, Huesca, Spain
| | | | | | - María José Ramírez
- Digestive Service, Hospital Universitari Parc Taulí, and CIBERehd, Sabadell, Spain
| | - Teresa Alarcon
- Microbiology Service, La Princesa University Hospital and Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Javier P Gisbert
- Gastroenterology Unit, La Princesa University Hospital, 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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6
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Molina-Infante J, Lucendo AJ, Angueira T, Rodriguez-Tellez M, Perez-Aisa A, Balboa A, Barrio J, Martin-Noguerol E, Gomez-Rodriguez BJ, Botargues-Bote JM, Gomez-Camarero J, Huerta A, Modolell I, Ariño I, Herranz-Bachiller MT, Bermejo F, McNicholl AG, O'Morain C, Gisbert JP. Optimised empiric triple and concomitant therapy for Helicobacter pylori eradication in clinical practice: the OPTRICON study. Aliment Pharmacol Ther 2015; 41:581-9. [PMID: 25776067 DOI: 10.1111/apt.13069] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 12/09/2014] [Accepted: 12/14/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Empiric triple therapy for Helicobacter pylori should be abandoned when clarithromycin resistance rate is >15-20%. Optimisation of triple therapy (high-dose acid suppression and 14-day duration) can increase eradication rates by 10%. AIM To compare the efficacy and safety of optimised triple (OPT-TRI) and nonbismuth quadruple concomitant (OPT-CON) therapies. METHODS Prospective multicentre study in 16 Spanish centres using triple therapy in clinical practice. In a 3-month two-phase fashion, the first 402 patients received an OPT-TRI therapy [esomeprazole (40 mg b.d.), amoxicillin (1 g b.d) and clarithromycin (500 mg b.d) for 14 days] and the last 375 patients an OPT-CON treatment [OPT-TRI therapy plus metronidazole (500 mg b.d)]. RESULTS Seven-hundred seventy-seven consecutive patients were included (402 OPT-TRI, 375 OPT-CON). The OPT-CON therapy achieved significantly higher eradication rates in the per-protocol [82.3% (95% CI = 78-86%) vs. 93.8% (91-96%), P < 0.001] and intention-to-treat analysis [81.3% (78-86%) vs. 90.4% (87-93%), P < 0.001]. Adverse events (97% mild/moderate) were significantly more common with OPT-CON therapy (39% vs. 47%, P = 0.016), but full compliance with therapy was similar between groups (94% vs. 92%, P = 0.4). OPT-CON therapy was the only significant predictor of successful eradication (odds ratio, 2.24; 95% CI: 1.48-3.51, P < 0.001). The rate of participating centres achieving cure rates ≥ 90% favoured OPT-CON therapy (OPT-TRI 25% vs. OPT-CON 62%). CONCLUSIONS Empiric OPT-CON therapy achieved significantly higher cure rates (>90%) compared to OPT-TRI therapy. Addition of metronidazole to OPT-TRI therapy increased eradication rates by 10%, resulting in more mild adverse effects, but without impairing compliance with therapy.
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Affiliation(s)
- J Molina-Infante
- Department of Gastroenterology, Hospital San Pedro de Alcantara, Caceres, Spain
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7
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Lanas A, Carrera-Lasfuentes P, García-Rodríguez LA, García S, Arroyo-Villarino MT, Ponce J, Bujanda L, Calleja JL, Polo-Tomas M, Calvet X, Feu F, Perez-Aisa A. Outcomes of peptic ulcer bleeding following treatment with proton pump inhibitors in routine clinical practice: 935 patients with high- or low-risk stigmata. Scand J Gastroenterol 2014; 49:1181-90. [PMID: 25144754 DOI: 10.3109/00365521.2014.950694] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess rates of further bleeding, surgery and mortality in patients hospitalized owing to peptic ulcer bleeding. MATERIALS AND METHODS Consecutive patients hospitalized for peptic ulcer bleeding and treated with a proton pump inhibitor (PPI) (esomeprazole or pantoprazole) were identified retrospectively in 12 centers in Spain. Patients were included if they had high-risk stigmata (Forrest class Ia-IIb, underwent therapeutic endoscopy and received intravenous PPI ≥120 mg/day for ≥24 h) or low-risk stigmata (Forrest class IIc-III, underwent no therapeutic endoscopy and received intravenous or oral PPI [any dose]). RESULTS Of 935 identified patients, 58.3% had high-risk stigmata and 41.7% had low-risk stigmata. After endoscopy, 88.3% of high-risk patients and 22.1% of low-risk patients received intravenous PPI therapy at doses of at least 160 mg/day. Further bleeding within 72 h occurred in 9.4% and 2.1% of high- and low-risk patients, respectively (p < 0.001). Surgery to stop bleeding was required within 30 days in 3.5% and 0.8% of high- and low-risk patients, respectively (p = 0.007). Mortality at 30 days was similar in both groups (3.3% in high-risk and 2.3% in low-risk patients). CONCLUSION Among patients hospitalized owing to peptic ulcer bleeding and treated with PPIs, patients with high-risk stigmata have a higher risk of further bleeding and surgery, but not of death, than those with low-risk stigmata.
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Affiliation(s)
- Angel Lanas
- Servicio de Aparato Digestivo, Hospital Clínico, Universidad de Zaragoza, IIS Aragón , Zaragoza , Spain
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McNicholl AG, Marin AC, Molina-Infante J, Castro M, Barrio J, Ducons J, Calvet X, de la Coba C, Montoro M, Bory F, Perez-Aisa A, Forné M, Gisbert JP. Randomised clinical trial comparing sequential and concomitant therapies for Helicobacter pylori eradication in routine clinical practice. Gut 2014; 63:244-9. [PMID: 23665990 DOI: 10.1136/gutjnl-2013-304820] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES No trial has compared non-bismuth quadruple 'sequential' and 'concomitant' regimens in settings with increasing clarithromycin rates. The study aims to compare the effectiveness and safety of these therapies for Helicobacter pylori treatment. DESIGN Prospective randomised clinical trial in 11 Spanish hospitals. Patients naïve to eradication therapy with non-investigated/functional dyspepsia or peptic ulcer disease were included. Randomised (1:1) to sequential (omeprazole (20 mg/12 h) and amoxicillin (1 g/12 h) for 5 days, followed by 5 days of omeprazole (20 mg/12 h), clarithromycin (500 mg/12 h) and metronidazole (500 mg/12 h)), or concomitant treatment (same drugs taken concomitantly for 10 days). Eradication was confirmed with (13)C-urea breath test or histology 4 weeks after treatment. Adverse events (AEs) and compliance were evaluated with questionnaires and residual medication count. RESULTS 338 consecutive patients were randomised. Mean age was 47 years, 60% were women, 22% smokers and 20% had peptic ulcer. Concomitant and sequential eradication rates were, respectively, 87% vs 81% by intention-to-treat (p=0.15) and 91% vs 86% (p=0.131) per protocol. Respective compliances were 83% vs 82%. Treatment-emergent AEs were reported in 59% of patients (no differences found between treatments). AEs were mostly mild (60%), and average length was 6.1 days, causing discontinuation only in 12 patients. Multivariate analysis: 'concomitant' treatment showed an OR of 1.5 towards better eradication rate in a borderline significance CI (95% CI 0.9 to 2.8). CONCLUSIONS Concomitant therapy led to a non-statistically significant advantage (5%) over sequential therapy, coming closer to 90% cure rates. Both therapies showed an acceptable safety profile. ClincialTrials.gov: NCT01273441.
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Affiliation(s)
- Adrian G McNicholl
- Digestive Services, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa (IP), , Madrid, Spain
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Gisbert JP, Perez-Aisa A, Rodrigo L, Molina-Infante J, Modolell I, Bermejo F, Castro-Fernández M, Antón R, Sacristán B, Cosme A, Barrio J, Harb Y, Gonzalez-Barcenas M, Fernandez-Bermejo M, Algaba A, Marín AC, McNicholl AG. Third-line rescue therapy with bismuth-containing quadruple regimen after failure of two treatments (with clarithromycin and levofloxacin) for H. pylori infection. Dig Dis Sci 2014; 59:383-9. [PMID: 24126798 DOI: 10.1007/s10620-013-2900-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 09/25/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Helicobacter pylori eradication therapy with a proton pump inhibitor (PPI), clarithromycin, and amoxicillin fails in >20 % of cases. A rescue therapy with PPI-amoxicillin-levofloxacin still fails in >20 % of patients. AIM To evaluate the efficacy and tolerability of a bismuth-containing quadruple regimen in patients with two consecutive eradication failures. METHODS Prospective multicenter study of patients in whom 1st treatment with PPI-clarithromycin-amoxicillin and 2nd with PPI-amoxicillin-levofloxacin had failed. A 3rd eradication regimen with a 7- to 14-day PPI (standard dose b.i.d.), bismuth subcitrate (120 mg q.i.d. or 240 mg b.i.d.), tetracycline (from 250 mg t.i.d. to 500 mg q.i.d.) and metronidazole (from 250 mg t.i.d. to 500 mg q.i.d.). Eradication was confirmed by (13)C-urea-breath-test 4-8 weeks after therapy. Compliance was determined through questioning and recovery of empty medication envelopes. Adverse effects were evaluated by means of a questionnaire. RESULTS Two hundred patients (mean age 50 years, 55 % females, 20 % peptic ulcer/80 % uninvestigated-functional dyspepsia) were initially included, and two were lost to follow-up. In all, 97 % of patients complied with the protocol. Per-protocol and intention-to-treat eradication rates were 67 % (95 % CI 60-74 %) and 65 % (58-72 %). Adverse effects were reported in 22 % of patients, the most common being nausea (12 %), abdominal pain (11 %), metallic taste (8.5 %), and diarrhea (8 %), none of them severe. CONCLUSION A bismuth-containing quadruple regimen is an acceptable third-line strategy and a safe alternative after two previous H. pylori eradication failures with standard clarithromycin- and levofloxacin-containing triple therapies.
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Affiliation(s)
- J P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria Princesa (IP), Playa de Mojácar 29. Urb. Bonanza., 28669, Boadilla del Monte, Madrid, Spain,
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Lanas A, Polo-Tomas M, García-Rodríguez LA, García S, Arroyo-Villarino MT, Ponce J, Bujanda L, Calleja JL, Calvet X, Feu F, Perez-Aisa A, Sung JJY. Effect of proton pump inhibitors on the outcomes of peptic ulcer bleeding: comparison of event rates in routine clinical practice and a clinical trial. Scand J Gastroenterol 2013; 48:285-94. [PMID: 23298283 DOI: 10.3109/00365521.2012.758764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess clinical outcomes in patients treated with proton pump inhibitors (PPIs) after endoscopic hemostasis in routine clinical care, and to compare these outcomes to those seen in a randomized controlled trial (RCT) of i.v. esomeprazole. MATERIALS AND METHODS Patients with peptic ulcer bleeding and endoscopic stigmata of recent hemorrhage, who were treated with i.v. esomeprazole or pantoprazole ≥120 mg/day following therapeutic endoscopy, were identified from 12 hospitals in Spain (n = 539). Outcomes assessed included further bleeding, all-cause mortality and surgery. The results were compared to those of the RCT. RESULTS Overall, 9.1% (95% confidence interval [CI]: 6.7-11.5) of patients experienced further bleeding within 72 h following initial endoscopy, 14.3% (95% CI: 11.3-17.2) of patients had further bleeding within 30 days and 3.3% (95% CI: 1.8-4.9) of patients died within 30 days. In the RCT, the rate of rebleeding within 72 h was significantly lower in the esomeprazole arm (5.9%) than in the placebo arm (10.3%; p = 0.026). The further bleeding rate in patients treated with esomeprazole in routine clinical practice (7.8%; 95% CI: 4.6-11.1) was between these two values. Similar results were seen with the other outcomes studied. CONCLUSIONS The proportion of patients treated with i.v. esomeprazole in routine clinical practice who experienced further bleeding following endoscopic treatment for peptic ulcer bleeding was between the rates observed in the esomeprazole group and the placebo group in the RCT.
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Affiliation(s)
- Angel Lanas
- Servicio de Aparato Digestivo, Hospital Clínico, Universidad de Zaragoza, IIS Aragón, Zaragoza, Spain.
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Rosales-Zabal JM, Romero-Ordoñez MA, Palma-Carazo F, Martinez-Santos MC, Sanchez-Yagüe A, Suarez-Aleman G, Perez-Aisa A, Sanchez-Cantos AM. Young Woman With Vomiting, Dyspnea, and Chest Pain. Ann Emerg Med 2012. [DOI: 10.1016/j.annemergmed.2012.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rosales-Zabal JM, Navarro-Jarabo JM, Rivera-Irigoin R, Perez-Aisa A, Marcos-Herrero M, Sanchez-Cantos AM. Rupture of a splenic pseudoaneurysm in the colon as an unusual cause of rectal bleeding. Colorectal Dis 2012; 14:e425-6. [PMID: 22177007 DOI: 10.1111/j.1463-1318.2011.02916.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- J M Rosales-Zabal
- Gastrointestinal Unit, Agencia Sanitaria Costa del Sol, Marbella, Malaga, Spain.
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13
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Gisbert JP, Castro-Fernandez M, Perez-Aisa A, Cosme A, Molina-Infante J, Rodrigo L, Modolell I, Cabriada JL, Gisbert JL, Lamas E, Marcos E, Calvet X. Fourth-line rescue therapy with rifabutin in patients with three Helicobacter pylori eradication failures. Aliment Pharmacol Ther 2012. [PMID: 22372560 DOI: 10.1111/j.1365-2036.2012.05053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND In some cases, Helicobacter pylori infection persists even after three eradication treatments. AIM To evaluate the efficacy of an empirical fourth-line rescue regimen with rifabutin in patients with three eradication failures. DESIGN Multicentre, prospective study. PATIENTS In whom the following three treatments had consecutively failed: first (PPI + clarithromycin + amoxicillin); second (PPI + bismuth + tetracycline + metronidazole); third (PPI + amoxicillin + levofloxacin). INTERVENTION A fourth regimen with rifabutin (150 mg b.d.), amoxicillin (1 g b.d.) and a PPI (standard dose b.d.) was prescribed for 10 days. OUTCOME Eradication was confirmed by (13) C-urea breath test 4-8 weeks after therapy. Compliance and tolerance: Compliance was determined through questioning and recovery of empty medication envelopes. Adverse effects were evaluated using a questionnaire. RESULTS One-hundred patients (mean age 50 years, 39% men, 31% peptic ulcer/69% functional dyspepsia) were included. Eight patients did not take the medication correctly (in six cases due to adverse effects). Per-protocol and intention-to-treat eradication rates were 52% (95% CI = 41-63%) and 50% (40-60%). Adverse effects were reported in 30 (30%) patients: nausea/vomiting (13 patients), asthenia/anorexia (8), abdominal pain (7), diarrhoea (5), fever (4), metallic taste (4), myalgia (4), hypertransaminasemia (2), leucopenia (<1,500 neutrophils) (2), thrombopenia (<150,000 platelets) (2), headache (1) and aphthous stomatitis (1). Myelotoxicity resolved spontaneously in all cases. CONCLUSIONS Even after three previous H. pylori eradication failures, an empirical fourth-line rescue treatment with rifabutin may be effective in approximately 50% of the cases. Therefore, rifabutin-based rescue therapy constitutes a valid strategy after multiple previous eradication failures with key antibiotics, such as clarithromycin, metronidazole, tetracycline and levofloxacin.
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Affiliation(s)
- J P Gisbert
- Gastroenterology Department, Hospital de La Princesa, Madrid, Spain.
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Gisbert JP, Castro-Fernandez M, Perez-Aisa A, Cosme A, Molina-Infante J, Rodrigo L, Modolell I, Cabriada JL, Gisbert JL, Lamas E, Marcos E, Calvet X. Fourth-line rescue therapy with rifabutin in patients with three Helicobacter pylori eradication failures. Aliment Pharmacol Ther 2012; 35:941-7. [PMID: 22372560 DOI: 10.1111/j.1365-2036.2012.05053.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 02/10/2012] [Accepted: 02/13/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND In some cases, Helicobacter pylori infection persists even after three eradication treatments. AIM To evaluate the efficacy of an empirical fourth-line rescue regimen with rifabutin in patients with three eradication failures. DESIGN Multicentre, prospective study. PATIENTS In whom the following three treatments had consecutively failed: first (PPI + clarithromycin + amoxicillin); second (PPI + bismuth + tetracycline + metronidazole); third (PPI + amoxicillin + levofloxacin). INTERVENTION A fourth regimen with rifabutin (150 mg b.d.), amoxicillin (1 g b.d.) and a PPI (standard dose b.d.) was prescribed for 10 days. OUTCOME Eradication was confirmed by (13) C-urea breath test 4-8 weeks after therapy. Compliance and tolerance: Compliance was determined through questioning and recovery of empty medication envelopes. Adverse effects were evaluated using a questionnaire. RESULTS One-hundred patients (mean age 50 years, 39% men, 31% peptic ulcer/69% functional dyspepsia) were included. Eight patients did not take the medication correctly (in six cases due to adverse effects). Per-protocol and intention-to-treat eradication rates were 52% (95% CI = 41-63%) and 50% (40-60%). Adverse effects were reported in 30 (30%) patients: nausea/vomiting (13 patients), asthenia/anorexia (8), abdominal pain (7), diarrhoea (5), fever (4), metallic taste (4), myalgia (4), hypertransaminasemia (2), leucopenia (<1,500 neutrophils) (2), thrombopenia (<150,000 platelets) (2), headache (1) and aphthous stomatitis (1). Myelotoxicity resolved spontaneously in all cases. CONCLUSIONS Even after three previous H. pylori eradication failures, an empirical fourth-line rescue treatment with rifabutin may be effective in approximately 50% of the cases. Therefore, rifabutin-based rescue therapy constitutes a valid strategy after multiple previous eradication failures with key antibiotics, such as clarithromycin, metronidazole, tetracycline and levofloxacin.
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Affiliation(s)
- J P Gisbert
- Gastroenterology Department, Hospital de La Princesa, Madrid, Spain.
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