Introduction

Global rise in primary Helicobacter pylori (H. pylori) antibiotic resistance has led to a decrease in the treatment efficacy. Understanding the rates of clarithromycin (ClaR), metronidazole (MetR) and levofloxacin (LevR) resistance in H. pylori management is essential for determining the optimal eradication therapy and achieving successful clinical outcomes.

Aims & Methods

To evaluate the prevalence and geographical distribution of H. pylori primary ClaR, MetR and LevR in Europe. Bibliographical searches were conducted in PubMed until March 2024, with no language restrictions. Studies focused on children only or non-European countries were excluded.

Results

A total of 218 studies published since 1990 were included, of which 188 provided information on ClaR, 138 on MetR, and 77 on LevR (Table 1). The average ClaR in Europe, considering all studies and years, was 17%, showing an increase from 7.3% in the 1990s to 26% in the period 2010–2019, with a slight decrease to 22% in the period 2020–2024. The highest values were reported in Switzerland (66%), Ireland (50%), and Israel (44%). Southern European countries presented higher resistance rates (over 15–20%) compared to those in the north (under 10–15%). MetR remained consistently high (with a European average of 34%), particularly in Poland (66%), Turkey (67%), and Switzerland (60%). As for LevR, it was low in the 1990s but experienced a progressive increase over time, reaching approximately 15% during 2010–2019, and fluctuating between 20% and 25% in recent years.

Conclusion

In Europe, since the 1990s, primary ClaR has fluctuated but always remaining above 15%; MetR has remained consistently high; and LevR has shown a progressive increase throughout the study periods. These data highlight the urgent need for region-specific antibiotic stewardship and updated treatment guidelines to ensure H. pylori eradication success.

Disclosure

Javier P. Gisbert has served as speaker, consultant, and advisory member for or has received research funding from: Mayoly, Allergan/Abbvie, Diasorin, Richen, Juvisé and Biocodex.
Olga P. Nyssen received research funding from: Mayoly, Allergan/Abbvie, Richen, Juvisé and Biocodex.

Introduction

Helicobacter pylori (HP) has been designated as a Grade I Carcinogen by the WHO and remains an important factor in the pathogenesis of intestinal-type gastric cancer. Gastric cancer was the fifth most common malignant disease in the world in 2022 (Globocan) with 968,784 new cases(1), after lung, breast, colorectal and prostate cancers. The incidence of gastric cancer has changed significantly since the first estimates in 1975, when stomach cancer was the leading cancer, and one of the most important factors has been the eradication of HP.(2)

Aims & Methods

The purpose of this study was to determinate the trends in the incidence of HP in our region, and also of the precancerous lesions.
There have been included in the study a group of 12541 patients from the years 2014-2018 and a group of 7138 patients from more recently years 2020-2024.
All the patients had dyspeptic syndrome and in all the patients upper digestive endoscopy has been performed in the Gastroenterology Clinic from Târgu Mureș, Emergency Clinical Hospital. Patients with haemorrhage were excluded from the study. In all the patients gastric biopsies and histopathological exam were made, OLGA classification was used.

Results

From the first group, in 2131 patients (52,9% males and 47,1% females) were found gastric changes. Histopathological, 32,7% of the patients had atrophic gastritis, 43,1% intestinal metaplasia (23,7% complete metaplasia and 19,4% incomplete metaplasia) and 0,7% dysplasia. Active gastritis/pangastritis with HP was identified in 59,3% of the patients. In 4,8% of cases there were revealed polyps (hyperplastic, adenomatous) and were removed.
In the second group from 2560 patients (54,4% males and 45,6 females) that underwent upper gastrointestinal with biopsy sampling, HP was present in 442 patients (17,26%.) Histopathological, 14,50% of the patients had atrophic gastritis, 23,8% intestinal metaplasia and 2,58% dysplasia.

Conclusion

HP incidence is decreasing, as it has been treated by the gastroenterologist and also by the general practitioner. The decreasing in incidence of HP is corelating with the decreasing of the precancerous lesions and gastric cancer, so ​it is worth to treat it.

References

1. Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, Cancer incidence and mortality worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: Inter- national Agency for Research on Cancer Available from: http://globocan.iarc.fr. Accessed 27.03.2025
2. Malfertheiner P, Megraud F, Rokkas T, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report, Gut 2022;71:1724–1762.

Disclosure

no conflict of interest

Introduction

It remains uncertain if the addition of Saccharomyces boulardii (S. boulardii) to Vonoprazan-amoxicillin dual therapy as a first-line treatment can enhance the Helicobacter pylori (H. pylori) eradication rate and decrease the incidence of adverse events. Therefore, we conducted the randomized controlled trials (RCTs) to address this issue.

Aims & Methods

This is a single-center, prospective randomized controlled study. A total of 150 eligible patients, recruited from December 2023 to November 2024, were randomly assigned to the VA (vonoprazan 20 mg twice daily, amoxicillin 750 mg 3 times daily for 10 days) and VAS groups (vonoprazan 20 mg twice daily, amoxicillin 750 mg 3 times daily, and S. boulardii 250 mg twice daily for 10 days). The eradication rates, adverse events, safety, and compliance were compared between the two groups. Factors associated with eradication rate were explored.

Results

The eradication rates of VA and VAS were 89.3% and 93.3%, respectively, by intention-to-treat analysis (P = 0.384); 93.1%, and 94.6%, respectively, by per-protocol analysis (P=0.966). The incidence of adverse events significantly lower in the VAS group (5.4%) than in the VA group (22.2%; P=0.003). There was no significant difference in compliance between the VA (96%) and VAS groups (98.7%, P = 0.612). Body surface area (BSA) was found to be a influencing factor for eradication rate in both VA and VAS groups. Serum chemistry tests revealed no significant differences in liver and kidney function before and after treatment in both groups.

Conclusion

Although the addition of S. boulardii to VA dual therapy could not increase the eradication rate, it could decrease the incidence of adverse events. Low-BSA patients are more suitable candidates for this regimen.

Introduction

Minocycline is considered the most potent semi-synthetic tetracycline, demonstrates promising pharmacokinetic and antimicrobial properties against Helicobacter pylori (H. pylori). While previous studies suggested the efficacy of minocycline-containing bismuth quadruple therapy for H. pylori eradication, real-world evidence remains limited.

Aims & Methods

his study aimed to evaluate the clinical efficacy, safety, and cost-effectiveness of minocycline-containing bismuth quadruple therapy in routine clinical practice.This multicenter, real-world observational study was conducted at 25 hospitals in Fujian China between January and March 2025. Patients diagnosed with H. pylori infection received one of three 14-day bismuth-containing quadruple regimens with b.i.d. esomeprazole 20 mg and bismuth 220 mg, plus amoxicillin 1000 mg b.i.d. and clarithromycin 250 mg b.i.d. (PBAC), or minocycline 100 mg b.i.d. and clarithromycin 250 mg b.i.d. (PBMC), or minocycline 100 mg twice b.i.d. and levofloxacin 500mg q.d. (PBML). The primary outcome was the H. pylori eradication rate, secondary outcomes included the frequency of adverse events, patient compliance, and cost-effectiveness.

Results

A total of 347 patients were enrolled, with 110 patients completing treatment in each group. In the intention-to-treat (ITT) analysis, eradication rates were 77.4% (PBAC), 85.5% (PBMC), and 84.3% (PBML). In the per-protocol (PP) analysis, eradication rates were 80.9%, 90.9%, and 88.2%, respectively. Although the differences among the three regimens were not statistically significant, minocycline-based regimens achieved numerically higher eradication rates. Adverse event incidence was 32.73%, 20.91%, and 23.64% in the three groups, respectively. Compliance rates exceeded 94% across all groups. Cost-effectiveness analysis showed PBML had the lowest cost-effectiveness ratio (5.38 CNY per 1% eradication), followed by PBAC (5.41 CNY) and PBMC (6.06 CNY).

Conclusion

H. pylori eradication, with favorable patient compliance and pharmacoeconomic profiles. These regimens present a viable alternative to traditional amoxicillin-or tetracycline-based therapies. Further large-scale randomized controlled trials are warranted to confirm these findings.

Introduction

Helicobacter pylori is class I carcinogen responsible for 89% of non cardia gastric cancer.

Aims & Methods

For the first time in Europe screen and treat application study was implemented in Maribor, Slovenia. The study was conducted by the National Institute for Public Health and Comunity Health Center Maribor. 5500 asymptomatic individuals 30-34 years of age were invited to participate (randomised sample). Additional 769 participants were included (nonrandomised group). The test-and-treat program was free of charge for all eligible participants. Locally validated H. pylori IgG serology and UBT as a confirmatory test were used. Quadruple bismuth based 14 day eradication therapy was the first line therapy. REDCap IT platform (pretreatment questionnaires, treatment protocols, side effects, compliance, complications…) was used to collect data for quality assurance, monitoring, and evaluation.

Results

Response rate to the written postal invitation was 24%; in men 21.7% and 29.7% in women (p<0,001). Gender and age distribution were similar in both study arms. There were in total of 2,105 persons who at minimum conducted a partial interview with the registered nurse. The seropositivity rate was 13,6% in randomised sample, 15,1% in nonrandomised sample and 14,2% in combined sample. Higher seropositivity rates was found in immigrants (36%,) and those participants whose highest finished level of education is a 2-year vocational school (33.3%, P >0,001). The dropout rate of -22.8% was recorded for participants with a positive serology who should continue with a confirmatory UBT. Second highest dropout rate of -19,9% was recorded for participants with a positive UBT result who were referred to treatment (12 pregnant women not included). Among the patients with a positive UBT 80.1% of total and 85.6% of randomised sample, respectively, initiated eradication therapy. Patients’ adherence towards treatment was 90.6%. The rate of reported adverse events was 35.9%, The most frequently reported symptoms were nausea, diarrhoea and abdominal pain. More men reported the absence of adverse events during therapy compared to women (76.5% versus 54.5%, respectively, p= 0.014). The eradication rate for 92 patients who concluded the therapy and were retested by UBT was 95,7%.

Conclusion

The combined use of primary serology testing and confirmatory UBT showed no evident shortcomings. The use of quadruple bismuth-based treatment scheme showed encouraging eradication and adherence rates, whereas the incidence of adverse events due to this therapy was within the acceptable range. Specific software/application should be created and integrated into existing information technology (IT) structures of the primary health care system to digitally support the process of preventive testing and treatment. Education and public awareness campaign to increase the participation rate are of crucial importance.

Introduction

Upper gastrointestinal bleeding (UGIB) is a common medical emergency, with peptic ulcer bleeding (PUB) accounting for up to 59% of cases. Effective risk assessment is essential for patient stratification, guiding clinical decisions on endoscopy timing, level of care, and discharge planning. Although several scoring systems exist for UGIB, most are designed for general use rather than specifically for PUB.

Aims & Methods

This study aims to evaluate the accuracy of six pre-endoscopic scoring systems—Glasgow-Blatchford Score (GBS), Modified GBS (MGBS), Rockall Score (RS), AIMS65, H3B2 and MAP score—in predicting intervention needs, clinical outcomes, and level of care in patients admitted with PUB. A retrospective cohort study was conducted between 2020 and 2023, including patients admitted with PUB at a tertiary center. Pre-endoscopic scores were assessed, and data on the hemostatic treatment, level of care, mortality, and rebleeding rates were collected and analyzed.

Results

A total of 364 patients (66.8% male; mean age 71.7±17 years; median Charlson Comorbidity Index (CCI): 5.2) were admitted. Most were hospitalized at level 1 (68.1%) and level 2 (30.2%) care units, with 75.3% requiring emergency endoscopic hemostasis. The best scores for predicting endoscopic treatment were GBS, MGBS, and H3B2 (AUROC 0.93, 0.91, and 0.87, respectively; p<0.001). For rebleeding risk, GBS and MGBS performed best (AUROC 0.70 and 0.68). However, overall predictive value for 1-year mortality was low, with RS performing best (AUROC 0.67), closely followed by the CCI (AUROC 0.66). GBS, H3B2, and MAP were the most effective for differentiating levels of care (p<0.001)

Conclusion

GBS and H3B2 demonstrated the highest accuracy in predicting the need for endoscopic treatment and rebleeding risk in PUB. However, while these scores are valuable for acute management, long-term outcomes may require additional prognostic factors in these patients.

References

1. Sasaki Y, Abe T, Kawamura N, et al. Prediction of the need for emergency endoscopic treatment for upper gastrointestinal bleeding and new score model: a retrospective study. BMC Gastroenterol. 2022;22(1):337. 2022 doi:10.1186/s12876-022-02413-8
2. Akhila Arya PV, Thulaseedharan NK, Raj R, et al. AIMS65, Glasgow-Blatchford bleeding score and modified Glasgow-Blatchford bleeding score in predicting outcomes of upper gastrointestinal bleeding: An accuracy and calibration study. Indian J Gastroenterol. 2023;42(4):496-504. doi:10.1007/s12664-023-01387-z
3. Tham J, Stanley A. Clinical utility of pre-endoscopy risk scores in upper gastrointestinal bleeding. Expert Rev Gastroenterol Hepatol. 2019;13(12):1161-1167. doi:10.1080/17474124.2019.1698292

Introduction

Helicobacter pylori (Hp) infection is highly prevalent in Portugal, affecting over 60% of the population. Antibiotic resistance poses a significant challenge to Hp treatment; however, empirical regimens remain the standard of care over susceptibility-guided approaches. This study aims to evaluate the most recommended therapeutic options for Hp eradication and to identify risk factors associated with treatment failure.

Aims & Methods

Prospective cohort study conducted in a single centre, including all patients treated for Hp infection between 2013 and 2024. We analysed four eradication regimens: triple therapy (Tri), bismuth quadruple therapy (QuadB), concomitant quadruple therapy (QuadC) and sequential quadruple therapy (QuadS). We collected data on patient demographics and clinical characteristics and compared adherence rates, treatment effectiveness and incidence of adverse events.

Results

Included 591 patients, with a median age of 57 years (IQR 47-66) and female sex 57.2%. The main indication for Hp testing was dyspeptic symptoms (61.1%). The prescribed therapeutic regimens were QuadC in 34.0% of patients, QuadB in 32.8%, Tri in 23.2% and QuadS in 10.0%. According to the intention-to-treat analysis, QuadC (92.9%) and QuadB (90.4%) showed significantly higher eradication rates compared with Tri (73.9%, p<0.001), with no difference observed for QuadS (84.2%, p=0.30 vs QuadC; p=0.61 vs QuadB). Adverse events were significantly less frequent with Tri (0.06%) and QuadS (0.02%) compared to QuadC (0.18%, p<0.01) and QuadB (0.17%, p<0.05), but overall adherence to treatment was 97.1%, with no significant difference among regimens (p=0.19). Logistic regression identified predictive factors for treatment failure: prior eradication attempts (OR 2.31; 95% CI 0.3-1.4), poor adherence (OR 14.5; 95% CI 0.7-4.7) and absence of statin use (OR 2.33; 95% CI 0.07-1.6), with an AUC of 0.72.

Conclusion

QuadC and QuadB therapies are more effective for Hp eradication but are associated with increased rates of adverse events, without a negative impact on overall treatment adherence. Therapeutic failure is more likely in non-naive patients, those with poor adherence to treatment and without statin use.