Nyssen, Olga PBordin, DmitryTepes, BojanPérez-Aisa, ÁngelesVaira, DinoCaldas, MariaBujanda, LuisCastro-Fernandez, ManuelLerang, FrodeLeja, MarcisRodrigo, LuísRokkas, TheodoreKupcinskas, LimasPérez-Lasala, JorgeJonaitis, LaimasShvets, OlegGasbarrini, AntonioSimsek, HalisAxon, Anthony T RBuzás, GyörgyMachado, Jose CarlosNiv, YaronBoyanova, LyudmilaGoldis, AdrianLamy, VincentTonkic, AntePrzytulski, KrzysztofBeglinger, ChristophVenerito, MarinoBytzer, PeterCapelle, LisetteMilosavljević, TomicaMilivojevic, VladimirVeijola, LeaMolina-Infante, JavierVologzhanina, LiudmilaFadeenko, GalinaAriño, InesFiorini, GiuliaGarre, AnaGarrido, JesúsF Pérez, CristinaPuig, IgnasiHeluwaert, FredericMegraud, FrancisO'Morain, ColmGisbert, Javier PHp-EuReg Investigators2023-02-092023-02-092020-09-21http://hdl.handle.net/10668/16292The 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.enhelicobacter pylorihelicobacter pylori - treatmentAdultAgedAnti-Bacterial AgentsDrug Therapy, CombinationEuropeFemaleHelicobacter InfectionsHelicobacter pyloriHumansMaleMiddle AgedPractice Patterns, Physicians'Prospective StudiesProton Pump InhibitorsRegistriesresearch article32958544open access10.1136/gutjnl-2020-3213721468-3288https://gut.bmj.com/content/gutjnl/70/1/40.full.pdf