Brglez Jurecic 14 | José María Huguet 15 | Noelia Alcaide 16 | Irina Voynovan 17 | José María Botargues Bote 18 | Inés Modolell 19 | Jorge Pérez Lasala 20 | Inés Ariño 21 | Laimas Jonaitis 22 | Manuel Dominguez-Cajal 23 | György Buzas 24 | Frode Lerang 25 | Monica Perona 26 | Dmitry Bordin 17 | Toni Axon 27 | Antonio Gasbarrini 28 | Ricardo Marcos Pinto 29 | Yaron Niv 30 | Limas Kupcinskas 22 | Ante Tonkic 31 | Marcis Leja 32 | Theodore Rokkas 33 | Lyudmila Boyanova 34 | Oleg Shvets 35 | Marino Venerito 36 | Peter Bytzer 37 | Adrian Goldis 38 | Ilkay Simsek 39 | Vincent Lamy 40 | Krzysztof Przytulski 41 | Lumír Kunovský 42 | Lisette Capelle 43 | Tomica Milosavljevic 44 | María Caldas 1 | Ana Garre 1 | Francis Mégraud 45 | Colm O'Morain 46 | Javier P. Gisbert 1 | On behalf of the Hp-EuReg Investigators 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 Additional supporting information may be found online in the Supporting Information section. How to cite this article: Nyssen OP, Perez-Aisa Á, Tepes B, et al; On behalf of the Hp-EuReg Investigators. 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.

Background The effectiveness of the switch to another anti–tumor necrosis factor (anti-TNF) agent is not known. The aim of this study was to analyze the effectiveness and safety of treatment with a second and third anti-TNF drug after intolerance to or failure of a previous anti-TNF agent in inflammatory bowel disease (IBD) patients. Methods We included patients diagnosed with IBD from the ENEIDA registry who received another anti-TNF after intolerance to or failure of a prior anti-TNF agent. Results A total of 1122 patients were included. In the short term, remission was achieved in 55% of the patients with the second anti-TNF. The incidence of loss of response was 19% per patient-year with the second anti-TNF. Combination therapy (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.8–3; P < 0.0001) and ulcerative colitis vs Crohn’s disease (HR, 1.6; 95% CI, 1.1–2.1; P = 0.005) were associated with a higher probability of loss of response. Fifteen percent of the patients had adverse events, and 10% had to discontinue the second anti-TNF. Of the 71 patients who received a third anti-TNF, 55% achieved remission. The incidence of loss of response was 22% per patient-year with a third anti-TNF. Adverse events occurred in 7 patients (11%), but only 1 stopped the drug. Conclusions Approximately half of the patients who received a second anti-TNF achieved remission; nevertheless, a significant proportion of them subsequently lost response. Combination therapy and type of IBD were associated with loss of response. Remission was achieved in almost 50% of patients who received a third anti-TNF; nevertheless, a significant proportion of them subsequently lost response.

Numerous disorders can alter the physiological mechanisms that guarantee proper digestion and absorption of nutrients (macro- and micronutrients), leading to a wide variety of symptoms and nutritional consequences. Malabsorption can be caused by many diseases of the small intestine, as well as by diseases of the pancreas, liver, biliary tract, and stomach. This article provides an overview of pathophysiologic mechanisms that lead to symptoms or complications of maldigestion (defined as the defective intraluminal hydrolysis of nutrients) or malabsorption (defined as defective mucosal absorption), as well as its clinical consequences, including both gastrointestinal symptoms and extraintestinal manifestations and/or laboratory abnormalities. The normal uptake of nutrients, vitamins, and minerals by the gastrointestinal tract (GI) requires several steps, each of which can be compromised in disease. This article will first describe the mechanisms that lead to poor assimilation of nutrients, and secondly discuss the symptoms and nutritional consequences of each specific disorder. The clinician must be aware that many malabsorptive disorders are manifested by subtle disorders, even without gastrointestinal symptoms (for example, anemia, osteoporosis, or infertility in celiac disease), so the index of suspicion must be high to recognize the underlying diseases in time.

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.

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.