European Registry onHelicobacter pylorimanagement (Hp-EuReg): patterns and trends in first-line empirical eradication prescription and outcomes of 5 years and 21 533 patients

Abstract

ObjectiveThe best approach for Helicobacter pylori management 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. 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.Results30 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%).ConclusionManagement 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.

European Registry on Helicobacter pylori Management: Effectiveness of First and Second-Line Treatment in Spain

“…This study is a sub-analysis focused on the Spanish centres actively participating in the "European Registry on H. pylori Management" (Hp-EuReg), an international (27 countries), multicentre (300 investigators), prospective non-interventional registry that started in 2013 and promoted by the European Helicobacter and Microbiota Study Group (www.helicobacter.org) [35]. The established Scientific Committee, national coordinators, gastroenterologist recruiting investigators and a list of variables and outcomes are detailed in the previously published protocol [36].…”

Rifabutin for the Treatment of Helicobacter pylori Infection: A Review

“…Finally, this bismuth-rifabutin regimen has recently been evaluated in the context of the "European Registry on H. pylori Management" (Hp-EuReg), an international multicenter prospective non-interventional registry starting in 2013 aimed to evaluate the decisions and outcomes in H. pylori management by European gastroenterologists [124]. Thirty European countries, with over 300 recruiters, are actively participating in this project, where patients are managed and registered according to their routine clinical practice [10]. To assess the effectiveness of empirical rescue therapies on third and subsequent lines in Europe, 1782 rescue treatments were evaluated in this registry.…”

“…At present, a rescue regimen including a quadruple combination of a PPI, bismuth, tetracycline, and metronidazole is generally used as the optimal second-line approach after initial H. pylori eradication failure [4][5][6]. However, this treatment fails to eradicate the infection in at least 20% of cases [7][8][9][10]. In addition, this regimen is associated with a high incidence of adverse events, is relatively complex, and many countries are currently experiencing a general unavailability of tetracycline and/or bismuth.…”

Adherence to Maastricht V/Florence consensus report for the management ofHelicobacter pyloriinfection among primary care physicians and medical students in Croatia: A cross‐sectional study

“…However, neither of the two regimens reliably achieved cure rates that would be expected of typical infectious disease therapies. These results indicate that gastroenterology has largely failed in its efforts to guide practitioners, further contributing to the emergence of antimicrobial resistance 27,28 . According to the results of a survey with PCPs from Israel during 2016, when the Maastricht IV consensus was in force, only 3.8% physicians have selected 4‐drug treatment protocol (bismuth‐based, non‐bismuth‐based quadruple therapy, and sequential therapy) for the first treatment line.…”