학술논문
Empirical rescue treatment of Helicobacter pyloriinfection in third and subsequent lines: 8-year experience in 2144 patients from the European Registry on H. pylorimanagement (Hp-EuReg)
Document Type
Article
Author
Burgos-Santamaría, Diego; Nyssen, Olga P; Gasbarrini, Antonio; Vaira, Dino; Pérez-Aisa, Ángeles; Rodrigo, Luís; Pellicano, Rinaldo; Keco-Huerga, Alma; Pabón-Carrasco, Manuel; Castro-Fernandez, Manuel; Boltin, Doron; Barrio, Jesus; Phull, Perminder; Kupcinskas, Juozas; Jonaitis, Laimas; Ortiz-Polo, Inmaculada; Tepes, Bojan; Lucendo, Alfredo J; Huguet, José María; Areia, Miguel; Jurecic, Natasa Brglez; Denkovski, Maja; Bujanda, Luís; Ramos-San Román, June; Cuadrado-Lavín, Antonio; Gomez-Camarero, Judith; Jiménez Moreno, Manuel Alfonso; Lanas, Angel; Martinez-Dominguez, Samuel Jesús; Alfaro, Enrique; Marcos-Pinto, Ricardo; Milivojevic, Vladimir; Rokkas, Theodore; Leja, Marcis; Smith, Sinead; Tonkić, Ante; Buzás, Gyo¨rgy Miklós; Doulberis, Michael; Venerito, Marino; Lerang, Frode; Bordin, Dmitry S; Lamy, Vincent; Capelle, Lisette G; Marlicz, Wojciech; Dobru, Daniela; Gridnyev, Oleksiy; Puig, Ignasi; Mégraud, Francis; O'Morain, Colm; Gisbert, Javier P
Source
Gut; 2023, Vol. 72 Issue: 6 p1054-1072, 19p
Subject
Language
ISSN
00175749; 14683288
Abstract
ObjectiveTo evaluate the use, effectiveness and safety of Helicobacter pyloriempirical rescue therapy in third and subsequent treatment lines in Europe.DesignInternational, prospective, non-interventional registry of the clinical practice of European gastroenterologists. Data were collected and quality reviewed until October 2021 at Asociación Española de Gastroenterología-Research Electronic Data Capture. All cases with three or more empirical eradication attempts were assessed for effectiveness by modified intention-to-treat and per-protocol analysis.ResultsOverall, 2144 treatments were included: 1519, 439, 145 and 41 cases from third, fourth, fifth and sixth treatment lines, respectively. Sixty different therapies were used; the 15 most frequently prescribed encompassed >90% of cases. Overall effectiveness remained <90% in all therapies. Optimised treatments achieved a higher eradication rate than non-optimised (78% vs 67%, p<0.0001). From 2017 to 2021, only 44% of treatments other than 10-day single-capsule therapy used high proton-pump inhibitor doses and lasted ≥14 days. Quadruple therapy containing metronidazole, tetracycline and bismuth achieved optimal eradication rates only when prescribed as third-line treatment, either as 10-day single-capsule therapy (87%) or as 14-day traditional therapy with tetracycline hydrochloride (95%). Triple amoxicillin-levofloxacin therapy achieved 90% effectiveness in Eastern Europe only or when optimised. The overall incidence of adverse events was 31%.ConclusionEmpirical rescue treatment in third and subsequent lines achieved suboptimal effectiveness in most European regions. Only quadruple bismuth-metronidazole-tetracycline (10-day single-capsule or 14-day traditional scheme) and triple amoxicillin-levofloxacin therapies reached acceptable outcomes in some settings. Compliance with empirical therapy optimisation principles is still poor 5 years after clinical practice guidelines update.Trial registration numberNCT02328131.