학술논문
European Registry on Helicobacter pylorimanagement (Hp-EuReg): patterns and trends in first-line empirical eradication prescription and outcomes of 5 years and 21 533 patients
Document Type
Article
Author
Nyssen, Olga P; Bordin, Dmitry; Tepes, Bojan; Pérez-Aisa, Ángeles; Vaira, Dino; Caldas, Maria; Bujanda, Luis; Castro-Fernandez, Manuel; Lerang, Frode; Leja, Marcis; Rodrigo, Luís; Rokkas, Theodore; Kupcinskas, Limas; Pérez-Lasala, Jorge; Jonaitis, Laimas; Shvets, Oleg; Gasbarrini, Antonio; Simsek, Halis; Axon, Anthony T R; Buzás, Gyo¨rgy; Machado, Jose Carlos; Niv, Yaron; Boyanova, Lyudmila; Goldis, Adrian; Lamy, Vincent; Tonkic, Ante; Przytulski, Krzysztof; Beglinger, Christoph; Venerito, Marino; Bytzer, Peter; Capelle, Lisette; Milosavljević, Tomica; Milivojevic, Vladimir; Veijola, Lea; Molina-Infante, Javier; Vologzhanina, Liudmila; Fadeenko, Galina; Ariño, Ines; Fiorini, Giulia; Garre, Ana; Garrido, Jesús; F Pérez, Cristina; Puig, Ignasi; Heluwaert, Frederic; Megraud, Francis; O'Morain, Colm; Gisbert, Javier P
Source
Gut; 2021, Vol. 70 Issue: 1 p40-54, 15p
Subject
Language
ISSN
00175749; 14683288
Abstract
ObjectiveThe best approach for Helicobacter pylorimanagement remains unclear. An audit process is essential to ensure clinical practice is aligned with best standards of care.DesignInternational multicentre prospective non-interventional registry starting in 2013 aimed to evaluate the decisions and outcomes in H. pylorimanagement 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.Results30 394 patients from 27 European countries were evaluated and 21 533 (78%) first-line empirical H. pyloritreatments 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%).ConclusionManagement of H. pyloriinfection 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.