<b><i>Helicobacter pylori</i></b> Eradication Rates in Slovenia in the Period from 2017 to 2019: Data from the European Registry on <b><i>H. pylori</i></b> Management

Abstract

Background. Helicobacter pylori (H pylori) is the most common chronic bacterial infection in the world, affecting over 50% of the world’s population. H pylori is a grade I carcinogen, responsible for the development of 89% of non-cardia gastric cancers. In the present study, we analyzed the data for H pylori eradication treatments in Slovenia after the 3rd National recommendations were implemented. Patients and methods. Slovenia is part of the European Registry on H pylori Management (Hp-EuReg) since the study was launched in 2013. Data were collected at AEG-REDCap e-CRF from September 2017 to December 2019. H pylori eradication treatment was assessed by modified intention-to-treat (mITT) and per-protocol (PP) analyses. Results. Overall, 823 patients from 3 medical institutions were included. Effectiveness with first line 14-day triple therapy with a proton-pomp-inhibitor (PPI), clarithromycin 500 mg, amoxicillin 1000 mg, all BID, was 93% by mITT (714 patients). In patients allergic to penicillin, first line 14-day triple therapy with PPI-clarithromycin-metronidazole achieved 83% effectiveness by mITT (35 patients). Second-line 14-day triple therapy with a PPI-amoxicillin-levofloxacin achieved 89% mITT eradication rate (51 patients). Second-line therapy with the 10-day three-in-one single capsule containing bismuth-tetracycline- metronidazole achieved optimal effectiveness (100% mITT) in 10 patients ( p=0.02). Conclusions. Slovenia is a country with &lt; 15% H pylori resistance to clarithromycin. Triple therapy with a PPI plus two antibiotics during 14 days reported optimal effectiveness (over 90%). Ten-day quadruple bismuth second-line therapy had better results than 14-day triple therapy with levofloxacin).

Evaluation of the Effectiveness of Helicobacter pylori Eradication Regimens in Lithuania during the Years 2013–2020: Data from the European Registry on Helicobacter pylori Management (Hp-EuReg)

“…A Slovenian study from the years 2013–2015 has concluded that even though only 11.4% of the total 1519 cases were lost to follow-up, the mITT eradication success rates were also suboptimal: the overall treatment effectiveness of standard triple therapy was only 72% and of the main second-line PPI, amoxicillin and levofloxacin regimen was 87.1% [ 45 ]. However, a more recent Slovenian study from the years 2017–2019 has clearly shown improvements: the 14 days duration first-line standard triple therapy has achieved optimal 93% success rate and the effectiveness of the main second-line 14 days regimen was 89% [ 46 ]. The already mentioned data from 21,533 cases from Hp-EuReg has shown significantly increasing H. pylori eradication rates in Eastern Europe (from ~62% to more than 80%) and eradication rates ranging from ~80% to >90% in other parts of the Europe [ 32 ].…”

Treatment of Helicobacter pylori Infection in Patients with Penicillin Allergy

“…Several studies have explored the efficacy and safety of PPI-Clarithromycin-Metronidazole for patients with penicillin allergy [ 24 , 25 , 28 , 30 , 32 , 35 , 39 , 41 ]. These studies utilized different PPIs, such as omeprazole, lansoprazole, esomeprazole, and rabeprazole, and the dose of metronidazole ranged from 500 mg to 1600 mg daily.…”

European Registry on Helicobacter pylori Management (Hp-EuReg): Most relevant results for clinical practice

“…• Previous failed therapy included: standard clarithromycin triple therapy (131 patients), sequential (32) and concomitant (37).…”

“…In total, 200 patients from Spain and Italy were evaluated: previous failed therapy included standard clarithromycin triple therapy (131 patients), sequential (32), and concomitant (37). Compliance was reported in 96% of patients.…”

“…To date, 14 studies have been published locally, providing a "country experience". Overall, three studies evaluated data in Spain (19,27,28), one in Greece (42), two in Slovenia (22,37), one in Lithuania (38), one in Israel (39), five in Russia (20, 21, 23, 29, 30), and one in Hungary (24). A synthesis of the most relevant conclusions from these studies is also reported in Table 2.…”