European Registry on <i>Helicobacter pylori</i> management (Hp-EuReg): patterns and trends in first-line empirical eradication prescription and outcomes of 5 years and 21 533 patients

Nyssen, Olga P.; Bordin, D.S.; Tepeš, Bojan; Pérez-Aísa, Ángeles; Vaira, Dino; Caldas, María; Bujanda, Luís; Castro‐Fernández, Manuel; Lerang, Frode; Leja, Mārcis; Rodrigo, Luís; Rokkas, Theodore; Kupčinskas, Limas; Pérez-Lasala, Jorge; Jonaitis, Laimas Virginijus; Shvets, Oleg; Gasbarrini, Antonio; Şimşek, Halis; Axon, Anthony; Buzás, György Miklós; Machado, José Carlos; Niv, Yaron; Boyanova, Lyudmila; Goldiş, Adrian; Lamy, V.; Tonkić, Ante; Przytulski, Krzysztof; Beglinger, Christoph; Marín, Alicia C; Bytzer, Peter; Capelle, Lisette; Milosavljević, Tomica; Milivojević, Vladimir; Veijola, Lea; Molina–Infante, Javier; Вологжанина, Л. Г.; Fadeenko, Galina; Ariño, I.; Fiorini, Giulia; Garre, Ana; Garrido, Jesús; Pérez, Cristina Fernández; Puig, Ignasi; Héluwaert, Frédéric; Mégraud, Françis; O’Morain, C.; Gisbert, Javier P.

doi:10.1136/gutjnl-2020-321372

Cited by 152 publications

(218 citation statements)

References 41 publications

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“…This study is a sub-analysis focused on the Spanish centres actively participating in the "European Registry on H. pylori Management" (Hp-EuReg), an international (27 countries), multicentre (300 investigators), prospective non-interventional registry that started in 2013 and promoted by the European Helicobacter and Microbiota Study Group (www.helicobacter.org) [35]. The established Scientific Committee, national coordinators, gastroenterologist recruiting investigators and a list of variables and outcomes are detailed in the previously published protocol [36].…”

Section: Methodsmentioning

confidence: 99%

European Registry on Helicobacter pylori Management: Effectiveness of First and Second-Line Treatment in Spain

et al. 2020

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The management of Helicobacter pylori infection has to rely on previous local effectiveness due to the geographical variability of antibiotic resistance. The aim of this study was to evaluate the effectiveness of first and second-line H. pylori treatment in Spain, where the empirical prescription is recommended. A multicentre prospective non-interventional registry of the clinical practice of European gastroenterologists concerning H. pylori infection (Hp-EuReg) was developed, including patients from 2013 until June 2019. Effectiveness was evaluated descriptively and through a multivariate analysis concerning age, gender, presence of ulcer, proton-pump inhibitor (PPI) dose, therapy duration and compliance. Overall, 53 Spanish hospitals were included, and 10,267 patients received a first-line therapy. The best results were obtained with the 10-day bismuth single-capsule therapy (95% cure rate by intention-to-treat) and with both the 14-day bismuth-clarithromycin quadruple (PPI-bismuth-clarithromycin-amoxicillin, 91%) and the 14-day non-bismuth quadruple concomitant (PPI-clarithromycin-amoxicillin-metronidazole, 92%) therapies. Second-line therapies were prescribed to 2448 patients, with most-effective therapies being the triple quinolone (PPI-amoxicillin-levofloxacin/moxifloxacin) and the bismuth-levofloxacin quadruple schemes (PPI-bismuth-levofloxacin-amoxicillin) prescribed for 14 days (92%, 89% and 90% effectiveness, respectively), and the bismuth single-capsule (10 days, 88.5%). Compliance, longer duration and higher acid inhibition were associated with higher effectiveness. “Optimized” H. pylori therapies achieve over 90% success in Spain.

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Section: Methodsmentioning

confidence: 99%

European Registry on Helicobacter pylori Management: Effectiveness of First and Second-Line Treatment in Spain

et al. 2020

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“…Finally, this bismuth-rifabutin regimen has recently been evaluated in the context of the "European Registry on H. pylori Management" (Hp-EuReg), an international multicenter prospective non-interventional registry starting in 2013 aimed to evaluate the decisions and outcomes in H. pylori management by European gastroenterologists [124]. Thirty European countries, with over 300 recruiters, are actively participating in this project, where patients are managed and registered according to their routine clinical practice [10]. To assess the effectiveness of empirical rescue therapies on third and subsequent lines in Europe, 1782 rescue treatments were evaluated in this registry.…”

Section: Addition Of Bismuthmentioning

confidence: 99%

“…At present, a rescue regimen including a quadruple combination of a PPI, bismuth, tetracycline, and metronidazole is generally used as the optimal second-line approach after initial H. pylori eradication failure [4][5][6]. However, this treatment fails to eradicate the infection in at least 20% of cases [7][8][9][10]. In addition, this regimen is associated with a high incidence of adverse events, is relatively complex, and many countries are currently experiencing a general unavailability of tetracycline and/or bismuth.…”

Section: Introductionmentioning

confidence: 99%

Rifabutin for the Treatment of Helicobacter pylori Infection: A Review

Gisbert¹

2020

Pathogens

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Nowadays, apart from having to know first-line Helicobacter pylori eradication regimens well, we must also be prepared to face treatment failures. The aim of this review is to summarize the role of rifabutin in the management of H. pylori infection. Bibliographical searches were performed in PubMed. Data on resistance and efficacy of rifabutin-containing regimens on H. pylori eradication were meta-analyzed. Mean H. pylori rifabutin resistance rate (39 studies, including 9721 patients) was 0.13%; when studies only including patients naïve to H. pylori eradication treatment were considered, this figure was even lower (0.07%). Mean H. pylori eradication rate (by intention-to-treat) with rifabutin-containing regimens (3052 patients) was 73%. Respective cure rates for second-, third-, fourth- and fifth-line therapies, were 79%, 69%, 69% and 72%. Most studies administered rifabutin 300 mg/day, which seemed to be more effective than 150 mg/day. The ideal length of treatment remains unclear, but 10–12-day regimens are generally recommended. Adverse events to rifabutin treatment in H. pylori studies were relatively infrequent (15%), and severe adverse events were exceptional (myelotoxicity was the most significant, although always reversible). In summary, rifabutin-containing therapy represents an encouraging strategy generally restricted, at present, to patients where previous (usually multiple) eradication regimens have failed.

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“…However, neither of the two regimens reliably achieved cure rates that would be expected of typical infectious disease therapies. These results indicate that gastroenterology has largely failed in its efforts to guide practitioners, further contributing to the emergence of antimicrobial resistance 27,28 . According to the results of a survey with PCPs from Israel during 2016, when the Maastricht IV consensus was in force, only 3.8% physicians have selected 4‐drug treatment protocol (bismuth‐based, non‐bismuth‐based quadruple therapy, and sequential therapy) for the first treatment line.…”

Section: Discussionmentioning

confidence: 99%

Adherence to Maastricht V/Florence consensus report for the management ofHelicobacter pyloriinfection among primary care physicians and medical students in Croatia: A cross‐sectional study

et al. 2020

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Background Helicobacter pylori (H pylori) eradication is becoming increasingly difficult. The aim of our study was to determine the knowledge of current guidelines and attitude in the diagnosis and treatment of H pylori infection in primary care physicians (PCPs) and medical students in Croatia. Materials and Methods A study was conducted among PCPs and medical students to evaluate adherence to Maastricht V consensus guidelines. Questionnaire was distributed by e‐mail to 2338 PCPs offices in Croatia and to the medical students from the University of Split School of Medicine. Responses were collected electronically from June 22 to August 22, 2020. Results Two hundred forty‐nine PCPs and 169 medical students were included in the study. Bismuth or non‐bismuth‐based quadruple therapy as first‐line treatment for H pylori was the choice of 4.8% of PCPs and 13% of students, while 66.3% PCPs and 79.9% students would choose clarithromycin‐based triple therapy. Bismuth‐based quadruple therapy was the most preferred second line of treatment for 45.4% of PCPs and 34.9% of students. Only 2.8% PCPs and 7.1% of students would correctly recommend first and second line of treatment for H. pylori infection. A larger proportion of students than PCPs would prefer C13‐urea breath test (50.3% vs 6.4%). Only 59.0% PCPs would treat for H pylori in all patients including the asymptomatic ones. Students more frequently recognized the link between H pylori and gastric cancer compared with PCPs (92.9% vs 73.5%). Conclusions Primary care physicians and medical students’ knowledge of H pylori guidelines are insufficient in Croatia and ask for additional training.

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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

Cited by 152 publications

References 41 publications

European Registry on Helicobacter pylori Management: Effectiveness of First and Second-Line Treatment in Spain

European Registry on Helicobacter pylori Management: Effectiveness of First and Second-Line Treatment in Spain

Rifabutin for the Treatment of Helicobacter pylori Infection: A Review

Adherence to Maastricht V/Florence consensus report for the management ofHelicobacter pyloriinfection among primary care physicians and medical students in Croatia: A cross‐sectional study

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