Protocol of the European Registry on the management of Helicobacter pylori infection (Hp‐EuReg)

Abstract

| INTRODUC TI ONHelicobacter pylori presence causes chronic gastritis in 100% of infected patients and is the major cause of relevant diseases such as atrophic gastritis, peptic ulcer disease, and gastric cancer. 1,2 H pylori eradication prevents peptic ulcer recurrence and its complications and decreases the incidence of gastric cancer. Furthermore, H pylori eradication in patients with peptic ulcer or even functional or noninvestigated dyspepsia is a cost-effective strategy. [3][4][5] Abstract Introduction: Helicobacter pylori selectively infects the human stomach, being the most prevalent chronic infection in the world. H pylori presence causes chronic gastritis in 100% of infected patients and is the major cause of relevant diseases such as atrophic gastritis, peptic ulcer disease, and gastric cancer; it is for this reason that from a public health standpoint, it is considered a high-impact pathogen, responsible of a significant morbidity and mortality. Nowadays, there are consensus and clinical guidelines regarding the infection management at a European level and in most of European countries, but no data have shown the level of implementation of these recommendations. The high costs that this infection carries both socially and to the health system require the continuous and systematic assessment of the diagnostic and treatment strategies, as well as the accessibility to diagnostic methods and most efficient drugs. Aim:To register the diagnosis, management strategies, and treatment of H pylori-infected adult patients in the Digestive Services outpatient clinics throughout Europe.Methods: Noninterventionist prospective multicentre international Registry promoted by the European Helicobacter and Microbiota Study Group. National Coordinators will select recruiting gastroenterologists in their country that will register the H pylori-related routine clinical practice consultations they receive in an electronic case report form (e-CRF) provided by AEG-REDCap. Variables retrieved will include clinical, diagnostic, treatment, eradication confirmation, and outcome data. The database will allow researchers to perform specific subanalyses after approval by the Scientific Committee of the study.

Spanish primary care survey on the management of Helicobacter pylori infection and dyspepsia: Information, attitudes, and decisions

“…The results challenge the current optimism regarding guidelines' impact on clinical practice. The clearest example from our data is that the most common first‐line treatment in primary care in Spain is still triple therapy with clarithromycin and amoxicillin (most common in 56% of doctors, similar to reported for European gastroenterologists, with a 65% use of triple therapies), even though the efficacy of this treatment in Spain is below 80% and it was substituted by quadruple regimens as first‐line treatment of choice in 2013 Spanish recommendations, and, what is more relevant, it is mostly prescribed as a 10‐day or less regimen (>50%), a scheme that has systematically performed below 80% efficacy in the area . Although this shows lack of alignment with recommendations, it is a significant improvement from the 2002 survey, where 77% provided a 7‐day triple therapy (vs only 12% today).…”

“…In conclusion, the real clinical practice that the Spanish health system is providing in primary care is suboptimal, and direct data from gastroenterologists' practice do not improve the overall picture . The authors of this article, as coordinators, collaborators, and scientific secretaries of different guidelines and consensus wonder if it is worth to dedicate so much effort to the publication of consensus and expect compliance from practitioners, without equivalent effort and support from the administration for a correct dissemination, and without surveillance of implementation and outcomes.…”

“…The final recommendation by implementation scientists is the need to identify potential barriers (cultural, economic, technologic, and bureaucratic) and to evaluate real‐time information of clinical practice implementation and outcomes using information technology programs . Since 2013, this approach is being followed by gastroenterology care in Europe through the “European Registry on H. pylori management” that includes over 25 000 patients from 27 countries . This registry shows a strong disparity of strategies that gastroenterologist has not yet adopted recent recommendations and that they are still following consensus recommendations older than a decade.…”

Review: Treatment of Helicobacter pylori Infection 2019

“…43,44 A study of 101 treatment naïve patients in China receiving also a quadruple regimen with bismuth resulted in a cure 88% of the time. A very large study from the European Registry on the Management of H pylori infection (Hp-EuReg) found that 1141 patients treated with first-line triple therapy plus bismuth achieved a 88% cure.…”

“…A very large study from the European Registry on the Management of H pylori infection (Hp-EuReg) found that 1141 patients treated with first-line triple therapy plus bismuth achieved a 88% cure. 43,44 A study of 101 treatment naïve patients in China receiving also a quadruple regimen with bismuth resulted in a cure 88% of the time. 45 Two studies looked at the "single triple" capsule regimen where bismuth and two antibiotics are given in the same capsule (Pylera ® ), along with a PPI.…”