European Registry on<i>Helicobacter pylori</i>management (Hp-EuReg): patterns and trends in first-line empirical eradication prescription and outcomes of 5 years and 21 533 patients
Olga P. Nyssen, Д.С. Бордин, Bojan Tepeš, Ángeles Pérez‐Aísa, Dino Vaira, María Caldas, Luís Bujanda, Manuel Castro‐Fernández, Frode Lerang, Mārcis Leja, Luı́s Rodrigo, Theodore Rokkas, Limas Kupčinskas, Jorge Pérez-Lasala, Laimas Virginijus Jonaitis, Oleg Shvets, Antonio Gasbarrini, Halis Simsek, Anthony Axon, György Miklós Buzás, José Carlos Machado, Yaron Niv, Lyudmila Boyanova, Adrian Goldiș, Vincent Lamy, Ante Tonkić, Krzysztof Przytulski, Christoph Beglinger, Marino Venerito, Peter Bytzer, Lisette G. Capelle, Tomica Milosavljević, Vladimir Milivojević, Lea Veijola, Javier Molina‐Infante, Л. Г. Вологжанина, Galina Fadeenko, Inés Ariño, Giulia Fiorini, Ana Garre, Jesús Garrido, Cristina Fernández, Ignasi Puig, Frédéric Heluwaert, Françis Mégraud, C O'Morain, Javier P. Gisbert
Abstract
OBJECTIVE: management remains unclear. An audit process is essential to ensure clinical practice is aligned with best standards of care. DESIGN: 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: 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: 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.