TY - JOUR
T1 - European Registry on Helicobacter pylori management (Hp-EuReg)
T2 - patterns and trends in first-line empirical eradication prescription and outcomes of 5 years and 21 533 patients
AU - Hp-EuReg Investigators
AU - Nyssen, Olga P
AU - Bordin, Dmitry
AU - Tepes, Bojan
AU - Pérez-Aisa, Ángeles
AU - Vaira, Dino
AU - Caldas, Maria
AU - Bujanda, Luis
AU - Castro-Fernandez, Manuel
AU - Lerang, Frode
AU - Leja, Marcis
AU - Rodrigo, Luís
AU - Rokkas, Theodore
AU - Kupcinskas, Limas
AU - Pérez-Lasala, Jorge
AU - Jonaitis, Laimas
AU - Shvets, Oleg
AU - Gasbarrini, Antonio
AU - Simsek, Halis
AU - Axon, Anthony T R
AU - Buzás, György
AU - Machado, Jose Carlos
AU - Niv, Yaron
AU - Boyanova, Lyudmila
AU - Goldis, Adrian
AU - Lamy, Vincent
AU - Tonkic, Ante
AU - Przytulski, Krzysztof
AU - Beglinger, Christoph
AU - Venerito, Marino
AU - Bytzer, Peter
AU - Capelle, Lisette
AU - Milosavljević, Tomica
AU - Milivojevic, Vladimir
AU - Veijola, Lea
AU - Molina-Infante, Javier
AU - Vologzhanina, Liudmila
AU - Fadeenko, Galina
AU - Ariño, Ines
AU - Fiorini, Giulia
AU - Garre, Ana
AU - Garrido, Jesús
AU - F Pérez, Cristina
AU - Puig, Ignasi
AU - Heluwaert, Frederic
AU - Megraud, Francis
AU - O'Morain, Colm
AU - Gisbert, Javier P
N1 - © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2021/1
Y1 - 2021/1
N2 - OBJECTIVE: 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.DESIGN: 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.RESULTS: 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%).CONCLUSION: 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.
AB - OBJECTIVE: 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.DESIGN: 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.RESULTS: 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%).CONCLUSION: 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.
U2 - 10.1136/gutjnl-2020-321372
DO - 10.1136/gutjnl-2020-321372
M3 - Article
C2 - 32958544
VL - 70
SP - 40
EP - 54
JO - Gut
JF - Gut
SN - 0017-5749
IS - 1
ER -