Room for Improvement in the Treatment of Helicobacter pylori Infection

Nyssen, Olga P.; Vaira, Dino; Tepeš, Bojan; Kupčinskas, Limas; Bordin, D.S.; Pérez-Aísa, Ángeles; Gasbarrini, Antonio; Castro‐Fernández, Manuel; Bujanda, Luís; Garre, Ana; Lucendo, Alfredo J.; Вологжанина, Л. Г.; Jurecic, Natasa Brglez; Rodrigo-Sáez, Luis; Huguet, José María; Voynovan, Irina; Pérez-Lasala, Jorge; Romero, Pilar Mata; Vujasinović, Miroslav; Абдулхаков, Р. А.; Barrio, Jesús; Fernández-Salazar, Luis; Mégraud, Françis; O’Morain, C.; Gisbert, Javier P.

doi:10.1097/mcg.0000000000001482

Cited by 50 publications

(25 citation statements)

References 33 publications

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“…Triple M + L option should not be used as an alternative in case of a penicillin allergy or as a second-line therapy option. This is in line with our findings of suboptimal effectiveness of triple M + L in treatment-naive patients (66.7% by mITT) [24].…”

Section: Discussionsupporting

confidence: 93%

Current Trends in the Management of Helicobacter pylori Infection in Serbia: Preliminary Results from the European Registry on H. pylori Management

Milivojević

Babic

Kekić

et al. 2022

Dig Dis

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Background: Helicobacter pylori (H. pylori) is the most common chronic bacterial infection. Treatment effectiveness remains a subject of debate considering bacterial antimicrobial resistance. Our aim was to analyse the diagnostic methods and eradication treatments for H. pylori infection in Serbia. Methods: An observational multicentre prospective study was conducted in Serbia, as part of the European Registry on H. pylori Management (Hp-EuReg). Demographics, treatment indication, diagnostic methods, previous eradication attempts and treatment were collected at AEG-REDCap e-CRF. Modified intention-to-treat (mITT) and per protocol (PP) effectiveness analyses were performed. Safety, compliance and bacterial antimicrobial resistance rates were reported. Data was quality checked. Results: Overall 283 patients were included, with a mean age of 55±15 years. Dyspepsia (n=214, 77%) was the most frequent treatment indication, and histology (n=144, 51%) was the most used diagnostic method. Overall eradication rate was 95% (PP) and 94% (mITT). Most prevalent first-line therapy was quadruple PPI+clarithromycin+amoxicillin+metronidazole, with a 96% effectiveness (p<0.001). Second-line main treatment choice was triple-amoxicillin+levofloxacin, with a 95% effectiveness (p<0.05). Single-capsule Pylera ® was the most prescribed third-line therapy, with 100% effectiveness (p<0.05). Longer treatment duration was associated with a higher eradication rate in first-line therapy (p<0.05). Clarithromycin and quinolone resistance rates in first-line were 24% and 8.3%, respectively. The overall adverse events' incidence rate was 13.4%, and therapy compliance was 97%. Conclusions: Considering the high eradication rate, 14-day non-bismuth quadruple concomitant therapy is a reasonable first-line choice, while quinolone-based therapy and single-capsule Pylera ® should be considered as rescue therapy options.

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Section: Discussionsupporting

confidence: 93%

Current Trends in the Management of Helicobacter pylori Infection in Serbia: Preliminary Results from the European Registry on H. pylori Management

Milivojević

Babic

Kekić

et al. 2022

Dig Dis

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“…Leading international experts dictate the rules for the diagnosis of H. pylori infection; however, the majority of mistakes are still made when assessing the effectiveness of eradication, namely, the use of inadequate methods or lack of control. According to the European Registry on H. pylori management (Hp-EuReg), confirmation of the eradication was performed in 94% of the cases [43].…”

Section: Discussionmentioning

confidence: 99%

Current Helicobacter pylori Diagnostics

et al. 2021

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The high prevalence of Helicobacter pylori and the variety of gastroduodenal diseases caused by this pathogen necessitate the use of only accurate methods both for the primary diagnosis and for monitoring the eradication effectiveness. There is a broad spectrum of diagnostic methods available for detecting H. pylori. All methods can be classified as invasive or non-invasive. The need for upper endoscopy, different clinical circumstances, sensitivity and specificity, and accessibility defines the method chosen. This article reviews the advantages and disadvantages of the current options and novel developments in diagnostic tests for H. pylori detection. The progress in endoscopic modalities has made it possible not only to diagnose precancerous lesions and early gastric cancer but also to predict H. pylori infection in real time. The contribution of novel endoscopic evaluation technologies in the diagnosis of H. pylori such as visual endoscopy using blue laser imaging (BLI), linked color imaging (LCI), and magnifying endoscopy is discussed. Recent studies have demonstrated the capability of artificial intelligence to predict H. pylori status based on endoscopic images. Non-invasive diagnostic tests such as the urea breathing test and stool antigen test are recommended for primary diagnosis of H. pylori infection. Serology can be used for initial screening and epidemiological studies. The histology showed its value in detecting H. pylori and provided more information about the degree of gastric mucosa inflammation and precancerous lesions. Molecular methods are mainly used in detecting antibiotic resistance of H. pylori. Cultures from gastric biopsies are the gold standard and recommended for antibiotic susceptibility tests.

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“…13 In addition, data from the European Registry on Helicobacter pylori management (Hp-EuReg) also showed that despite the high pretreatment clarithromycin resistance rate of 23% in Europe, the standard triple therapy containing both amoxicillin and clarithromycin remains as the most commonly prescribed (39%) H. pylori infection treatment, achieving only an 81.5% modified intention-to-treat eradication rate. 14,15 Therefore, in this study, we aimed to (1) review current first-line eradication regimens with a perprotocol eradication rate exceeding 90% in most geographic area, and (2) identify appropriate empirical H. pylori eradication strategies in regions with high and low clarithromycin resistances.…”

Section: Introductionmentioning

confidence: 99%

Update on the first-line treatment of Helicobacter pylori infection in areas with high and low clarithromycin resistances

Shih

Shie

Hsu

2022

Therap Adv Gastroenterol

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Current international consensuses on Helicobacter pylori eradication therapy recommend that only regimens that reliably produce eradication rates of ⩾90% should be used for empirical treatment. The Real-world Practice & Expectation of Asia-Pacific Physicians and Patients in Helicobacter Pylori Eradication Survey also showed that the accepted minimal eradication rate in H. pylori-infected patients was 91%. According to efficacy prediction model, the per-protocol eradication rates of 7-day and 14-day standard triple therapies fall below 90% when clarithromycin resistance rate ⩾5%. Several strategies including bismuth-containing, non-bismuth-containing quadruple therapies (including sequential, concomitant, hybrid and reverse hybrid therapies), high-dose dual therapy and vonoprazan-based triple therapy have been proposed to increase the eradication rate of H. pylori infection. According to efficacy prediction model, the eradication rate of 14-day concomitant therapy, 14-day hybrid therapy and 7-day vonoprazan-based triple therapy is less than 90% if the frequency of clarithromycin-resistant strains is higher than 90%, 58% and 23%, respectively. To meet the recommendation of the consensus report and patients’ expectation, local surveillance networks for resistance of H. pylori to clarithromycin are required to select appropriate eradication regimens in each geographic region. In areas with low (<5%) clarithromycin resistance (e.g. Sweden, Philippine, Myanmar and Bhutan), 7-day and 14-day standard triple therapies can be adopted for the first-line treatment of H. pylori infection with eradication rates of ⩾90%. In areas with high (⩾5%) clarithromycin resistance (most other countries worldwide) or unknown clarithromycin resistance, 14-day hybrid, 14-day reverse hybrid, 14-day concomitant and 10- to 14-day bismuth quadruple therapy can be used to treat H. pylori infection.

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Room for Improvement in the Treatment of Helicobacter pylori Infection

Abstract: Supplemental Digital Content is available in the text.

Cited by 50 publications

References 33 publications

Current Trends in the Management of Helicobacter pylori Infection in Serbia: Preliminary Results from the European Registry on H. pylori Management

Current Trends in the Management of Helicobacter pylori Infection in Serbia: Preliminary Results from the European Registry on H. pylori Management

Current Helicobacter pylori Diagnostics

Update on the first-line treatment of Helicobacter pylori infection in areas with high and low clarithromycin resistances

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