European Registry on Helicobacter pylori management (Hp-EuReg): patterns and trends in first-line empirical eradication prescription and outcomes of 5 years and 21 533 patients
Olga Nyssen
(1)
,
Dmitry Bordin
(2, 3)
,
Bojan Tepes
(4)
,
Ángeles Pérez-Aisa
(5)
,
Dino Vaira
(6)
,
Maria Caldas
(1)
,
Luis Bujanda
(7, 8)
,
Manuel Castro-Fernandez
(8)
,
Frode Lerang
(9)
,
Marcis Leja
(10)
,
Luís Rodrigo
(11)
,
Theodore Rokkas
(12)
,
Limas Kupcinskas
(13)
,
Jorge Pérez-Lasala
(14)
,
Laimas Jonaitis
(13)
,
Oleg Shvets
(14)
,
Antonio Gasbarrini
(15)
,
Halis Simsek
(16)
,
Anthony Axon
(17)
,
György Buzás
(18)
,
Jose Carlos Machado
(19)
,
Yaron Niv
(20)
,
Lyudmila Boyanova
(21)
,
Adrian Goldis
(22)
,
Vincent Lamy
(23)
,
Ante Tonkic
(24)
,
Krzysztof Przytulski
(25)
,
Christoph Beglinger
(26)
,
Marino Venerito
(27)
,
Peter Bytzer
(28)
,
Lisette Capelle
(29)
,
Tomica Milosavljević
(30)
,
Vladimir Milivojevic
(30)
,
Lea Veijola
(31)
,
Javier Molina-Infante
(32)
,
Liudmila Vologzhanina
(33)
,
Galina Fadeenko
(34)
,
Ines Ariño
(35)
,
Giulia Fiorini
(1)
,
Ana Garre
(1)
,
Jesús Garrido
(36, 37, 1)
,
Cristina F Pérez
(38)
,
Ignasi Puig
(37)
,
Frederic Heluwaert
(39)
,
Francis Megraud
(40, 41)
,
Colm O'Morain
(42)
,
Javier Gisbert
(1, 8)
1
UAM -
Universidad Autónoma de Madrid
2 AS Loginov Moscow Clinical Scientific Center [Moscow, Russian Federation]
3 A.I. Yevdokimov Moscow State University of Medicine and Dentistry [Moscow, Russian Federation]
4 AM DC Rogaska [Rogaska Slatina, Slovenia]
5 Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC)
6 UNIBO - Alma Mater Studiorum Università di Bologna = University of Bologna
7 UPV / EHU - Universidad del País Vasco [Espainia] / Euskal Herriko Unibertsitatea [España] = University of the Basque Country [Spain] = Université du pays basque [Espagne]
8 CIBERehd - Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas
9 Østfold Hospital
10 LU - University of Latvia
11 Universidad de Oviedo = University of Oviedo
12 Henry Dunant Hospital [Athens, Greece]
13 LSMU - Lithuanian University of health Sciences
14 Hospital Universitario HM Sanchinarro [Madrid, Spain]
15 Unicatt - Università cattolica del Sacro Cuore = Catholic University of the Sacred Heart [Roma]
16 Faculty of Medicine [Hacettepe University]
17 LGI - Leeds General Infirmary
18 Ferencváros Health Centre [Budapest, Hungary]
19 FMUP - Faculdade de Medicina da Universidade do Porto
20 TAU - Tel Aviv University
21 Medical University of Sofia [Bulgarie]
22 Timisoara Hospital [Timisoara, Romania]
23 Centre Hospitalier Universitaire de Charleroi
24 University of Split
25 Medical Centre for Postgraduate Education [Warsaw, Poland]
26 University Hospital Basel [Basel]
27 OVGU - Otto-von-Guericke-Universität Magdeburg = Otto-von-Guericke University [Magdeburg]
28 Copenhagen University Hospital
29 Meander Medical Center [Amersfoort, Netherlands]
30 University of Belgrade [Belgrade]
31 Herttoniemi Hospital [Helsinki, Finland]
32 San Pedro de Alcantara Hospital [Cáceres, Espagne]
33 Gastrocentr [Perm, Russian Federation]
34 Digestive Ukrainian Academy of Medical Sciences [Kyiv, Ukraine]
35 Hospital Clínico Universitario “Lozano Blesa” [Zaragoza, Spain]
36 Althaia Xarxa Assistencial Universitària de Manresa [Manresa, Spain]
37 UVicUCC - Universitat de Vic-Universitat Central de Catalunya [Manresa, Spain]
38 CHUS - Complejo Hospitalario Universitario de Santiago de Compostela [Saint-Jacques-de-Compostelle, Espagne]
39 Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois]
40 Physiopathologie du cancer du foie
41 Hôpital Pellegrin
42 Trinity College Dublin
2 AS Loginov Moscow Clinical Scientific Center [Moscow, Russian Federation]
3 A.I. Yevdokimov Moscow State University of Medicine and Dentistry [Moscow, Russian Federation]
4 AM DC Rogaska [Rogaska Slatina, Slovenia]
5 Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC)
6 UNIBO - Alma Mater Studiorum Università di Bologna = University of Bologna
7 UPV / EHU - Universidad del País Vasco [Espainia] / Euskal Herriko Unibertsitatea [España] = University of the Basque Country [Spain] = Université du pays basque [Espagne]
8 CIBERehd - Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas
9 Østfold Hospital
10 LU - University of Latvia
11 Universidad de Oviedo = University of Oviedo
12 Henry Dunant Hospital [Athens, Greece]
13 LSMU - Lithuanian University of health Sciences
14 Hospital Universitario HM Sanchinarro [Madrid, Spain]
15 Unicatt - Università cattolica del Sacro Cuore = Catholic University of the Sacred Heart [Roma]
16 Faculty of Medicine [Hacettepe University]
17 LGI - Leeds General Infirmary
18 Ferencváros Health Centre [Budapest, Hungary]
19 FMUP - Faculdade de Medicina da Universidade do Porto
20 TAU - Tel Aviv University
21 Medical University of Sofia [Bulgarie]
22 Timisoara Hospital [Timisoara, Romania]
23 Centre Hospitalier Universitaire de Charleroi
24 University of Split
25 Medical Centre for Postgraduate Education [Warsaw, Poland]
26 University Hospital Basel [Basel]
27 OVGU - Otto-von-Guericke-Universität Magdeburg = Otto-von-Guericke University [Magdeburg]
28 Copenhagen University Hospital
29 Meander Medical Center [Amersfoort, Netherlands]
30 University of Belgrade [Belgrade]
31 Herttoniemi Hospital [Helsinki, Finland]
32 San Pedro de Alcantara Hospital [Cáceres, Espagne]
33 Gastrocentr [Perm, Russian Federation]
34 Digestive Ukrainian Academy of Medical Sciences [Kyiv, Ukraine]
35 Hospital Clínico Universitario “Lozano Blesa” [Zaragoza, Spain]
36 Althaia Xarxa Assistencial Universitària de Manresa [Manresa, Spain]
37 UVicUCC - Universitat de Vic-Universitat Central de Catalunya [Manresa, Spain]
38 CHUS - Complejo Hospitalario Universitario de Santiago de Compostela [Saint-Jacques-de-Compostelle, Espagne]
39 Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois]
40 Physiopathologie du cancer du foie
41 Hôpital Pellegrin
42 Trinity College Dublin
Olga Nyssen
- Fonction : Auteur
- PersonId : 803479
- ORCID : 0000-0002-4920-9310
Luis Bujanda
- Fonction : Auteur
- PersonId : 767541
- ORCID : 0000-0002-4353-9968
Giulia Fiorini
- Fonction : Auteur
- PersonId : 803480
- ORCID : 0000-0003-0381-8302
Francis Megraud
- Fonction : Auteur
- PersonId : 760818
- ORCID : 0000-0002-2481-1612
- IdRef : 029980194
Javier Gisbert
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- Fonction : Auteur correspondant
- PersonId : 1081303
Connectez-vous pour contacter l'auteur
Résumé
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.