The multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group (EHMSG) is conducted in 27 countries in Europe. The data from the Russian part of the European registry for the management of Helicobacter pylori infection (European Registry on the management of Helicobacter pylori infection, protocol: “Hp-EuReg”) allows us to analyze the real clinical practice of diagnosis and treatment of H. pylori and compare it with international recommendations. Materials and methods. A comparative analysis of the data entered in the register by the Russian research centers “Hp-EuReg”, in the period from 2013 to 2018, was conducted. Results and discussion. Invasive diagnostic methods prevail for the primary diagnosis of H. pylori [histology - 20.3% (in 2013 year) - 43.9% (in 2018 year), rapid urease test - 31.7% and 47.8% respectively]. The most popular mode of eradication therapy is a 10-day triple therapy (62.8-76.2%), the effectiveness of which does not exceed 79% (per protocol). Invasive tests (histology) are the leading method for control the effectiveness of therapy, however, there is a tendency towards a wider use of non-invasive methods (H. pylori stool antigen - from 17% in 2013 to 29.3% in 2018 and urea breath test from 6.9 to 18.3%, respectively). Serological test to control the effectiveness of eradication is still used from 8.2% (2013) to 6.1% (2018). Eradication therapy was not performed in 28% of patients throughout the entire observation period. Conclusion. In Russia, despite approved domestic and international recommendations, deviations in clinical practice persist, both during eradication therapy and in monitoring the effectiveness of eradication therapy.
Diagnostic tests used to detection Helicobacter pylori are divided into invasive (requiring endoscopy) and non-invasive, direct (bacteriological, histological or molecular detection of the bacterium) and indirect (detection of urease activity of the bacterium or antibodies to it). The choice of the test is determined by the clinical situation, as well as by its availability and cost. The sensitivity of most tests is affected by the use of antisecretory drugs and antibiotics.
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.
On behalf of the scientific Committee and researchers Hp-EuReg European Registry on the management of Helicobacter pylori infection («Hp-EuReg») - a multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group, conducted in 27 European countries in order to evaluate the real clinical practice of diagnosis and treatment of H. pylori and its comparison with international recommendations. Materials and methods. The analysis of 2360 patients entered in the register by the Russian centres of «Hp-EuReg» in 2013-2017, who were underwent 1st line eradication therapy. Results. The most common methods of primary diagnosis of H. pylori are histological (37.7%), rapid urease test (29.2%) and serology (29.7%). The duration of eradication therapy in 9.4% of cases was 7 days, in 65.3% - 10 days, and in 25.3% - 14 days. To control the effectiveness of treatment, H. pylori antigen in feces (31.3%), urea breath test (23.4%) and histological method (23.3%) were used. In 3.6% cases was used serology by mistake. In 17.3% of patients control was not carried out. The effectiveness of triple therapy with a PPI, amoxicillin, clarithromycin (per protocol) was 67.6%, with 7-day course, 81.1% at 10-day and 86.7% at 14-day course. Еradication rate of triple therapy with addition of bismuth (per protocol) reached 90,6% in the group receiving 10-day scheme and 93.6% in the group receiving the 14-day treatment. Conclusion. Significant deviations of clinical practice from expert recommendations, most pronounced at the stage of monitoring the effectiveness of therapy, were noted. The suboptimal efficacy of triple therapy is shown.
The aim of the study was to identify the epidemiological and clinical factors predisposing to non-erosive reflux disease (NERD), erosive esophagitis (EE) and Barrett’s esophagus in Russian population of patients, and to develop a diagnostic model for GERD phenotypes. Materials and methods. 1433 patients with GERD from Moscow, Moscow region, St. Petersburg and Leningrad region were studied. During the study complaints and anamnestic data were gathered, anthropometry, tests for H. pylori infection and upper endoscopy were performed. Spearman rank correlation was used to identify the correlation of clinical characteristics with NERD, EE and Barrett’s esophagus. 880 patients with GERD (407 with NERD, 443 with EE, 27 with Barrett’s esophagus, 3 with esophageal stricture) were selected for correlation analysis due to the presence of all necessary parameters. To develop multivariable model for GERD phenotype diagnosis (EE/NERD), multivariate analyses was used. The prognostic value of multivariable model was determined based on ROC analysis. Results. The prevalence of two main GERD phenotypes - EE and NERD - was approximately equal in the patients of Russian megapolises. Male gender was significantly negatively correlated with NERD development (p=0.002011). An inverse correlation was found between NERD and older age groups (p=0.002459), high waist circumference (WC) (p=0.003733), long duration of GERD symptoms (p=0.012984), the results of the GerdQ≥8 points (p=0.040030). In the group of patients with EE grade A-B, a significant inverse correlation was revealed with age over 40 years (p=0.002708), high body mass index (BMI) (p=0.020957), and high WC (p=0.001293). The male gender (p=0.000108) and the duration of GERD symptoms more than 3 years (p=0.028292) were significantly associated with severe grades of EE development. The male gender (p=0.007505) and not using of PPIs over the past 6 months (p=0.015930) were positively associated with Barrett's esophagus. Based on correlation analyses and predictive value 6 variables associated with EE/NERD were chosen: gender, age, GERDQ results, GERD symptoms duration, WC, BMI. Variables were divided into classes with similar risk with corresponding scores. The cut-off point (total score) with balance of sensitivity and specificity (Se≈Sp) was 549. Area under the curve (AUC) was 0,73, which indicates good quality of the diagnostic model. Conclusion. Female gender, young age, normal BMI and WC, short duration of symptoms and GERD-Q less than 7 points were positively associated with NERD compared with EE among Russian patients. Male patients with long-term GERD symptoms, with overweight and obesity, who do not take PPIs are at high risk of Barrett's esophagus.
This publication summarizes and systematizes the data available in the literature on chronic autoimmune gastritis (CAG) in order to increase the awareness of specialists about the modern possibilities of diagnosing the disease, including in the early stages. Possible variants of the disease clinical manifestation include gastrointestinal, hematological (primarily, the formation of iron deficiency and B12-deficiency anemia), as well as neurological. Patients with CAG are characterized by comorbidity with other autoimmune diseases. Presented the data on the most informative serological markers of the diagnosis of CAG, as well as laboratory tests to detect micronutrient deficiency, information about characteristic changes in the gastric mucosa and the prognosis of the disease. The diagnosis of CAG should be based on a multidisciplinary approach that combines a thorough analysis of patient complaints with a mandatory assessment of nutritional status, the results of serological, endoscopic and histological methods of research
a. GERD is a widespread disease, which is associated with increased risk of Barrett's esophagus and esophageal adenocarcinoma.b. However, no data on risk factors predisposing to the development of non-erosive reflux disease, erosive esophagitis and Barrett's esophagus in Russia is available.I. What are the significant and/or new findings of this study?a. We showed that female gender, young age, normal BMI and WC, short duration of GERD symptoms and Gerd-Q results<7 points were positively associated with NERD.b. We showed that male patients with long-term GERD symptoms who do not use PPIs are at high risk of Barrett's esophagus.
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