Publication: 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.
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Date
2020-09-21
Authors
Nyssen, Olga P
Bordin, Dmitry
Tepes, Bojan
Pérez-Aisa, Ángeles
Vaira, Dino
Caldas, Maria
Bujanda, Luis
Castro-Fernandez, Manuel
Lerang, Frode
Leja, Marcis
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Abstract
The best approach for Helicobacter pylori management remains unclear. An audit process is essential to ensure clinical practice is aligned with best standards of care. International multicentre prospective non-interventional registry starting in 2013 aimed to evaluate the decisions and outcomes in H. pylori management by European gastroenterologists. Patients were registered in an e-CRF by AEG-REDCap. Variables included demographics, previous eradication attempts, prescribed treatment, adverse events and outcomes. Data monitoring was performed to ensure data quality. Time-trend and geographical analyses were performed. 30 394 patients from 27 European countries were evaluated and 21 533 (78%) first-line empirical H. pylori treatments were included for analysis. Pretreatment resistance rates were 23% to clarithromycin, 32% to metronidazole and 13% to both. Triple therapy with amoxicillin and clarithromycin was most commonly prescribed (39%), achieving 81.5% modified intention-to-treat eradication rate. Over 90% eradication was obtained only with 10-day bismuth quadruple or 14-day concomitant treatments. Longer treatment duration, higher acid inhibition and compliance were associated with higher eradication rates. Time-trend analysis showed a region-dependent shift in prescriptions including abandoning triple therapies, using higher acid-inhibition and longer treatments, which was associated with an overall effectiveness increase (84%-90%). Management of H. pylori infection by European gastroenterologists is heterogeneous, suboptimal and discrepant with current recommendations. Only quadruple therapies lasting at least 10 days are able to achieve over 90% eradication rates. European recommendations are being slowly and heterogeneously incorporated into routine clinical practice, which was associated with a corresponding increase in effectiveness.
Description
MeSH Terms
Adult
Aged
Anti-Bacterial Agents
Drug Therapy, Combination
Europe
Female
Helicobacter Infections
Helicobacter pylori
Humans
Male
Middle Aged
Practice Patterns, Physicians'
Prospective Studies
Proton Pump Inhibitors
Registries
Aged
Anti-Bacterial Agents
Drug Therapy, Combination
Europe
Female
Helicobacter Infections
Helicobacter pylori
Humans
Male
Middle Aged
Practice Patterns, Physicians'
Prospective Studies
Proton Pump Inhibitors
Registries
DeCS Terms
CIE Terms
Keywords
helicobacter pylori, helicobacter pylori - treatment