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PRESCRIPTIONS AND EFFECTIVENESS OF ALTERNATIVE AND INFREQUENT HELICOBACTER PYLORI ERADICATION REGIMENS: INSIGHTS FROM THE EUROPEAN REGISTRY ON H. PYLORI MANAGEMENT (HP-EUREG)

Irina Luzko 1, Sabir Sagdati 2, György Miklós Buzás 3, Ángeles Pérez-Aísa 4, Ana Garre Vázquez 5, Sotirios Georgopoulos 6, Sayar Abdulkhakov 7, Thomas Butler 8, Natalia Bakulina 9, Tatiana Ilchishina 10, Igor Bakulin 9, Umud Mahmudov 11, Laimas Virginijus Jonaitis 12, Irina Voynovan 13, Antonio Mestrovic 14, Doron Boltin 15, Oleg Zaytsev 16, Samuel Jesús Martínez-Domínguez 17, Natalia Dekhnich 18, Luis Bujanda Fernández de Piérola 19, Galina Tarasova 20, Inna V. Savilova 9, IVAN NAGORNI 21, Mila Kovacheva-Slavova 22, Jesús Barrio Andrés 23, Boris Starostin 24, Liudmila Vologzhanina 25, Debora Compare 26, Emin Verdiyev 27, Alfredo J. Lucendo 28, Gülüstan Babayeva 29, Vladimir Milivojevic 30, Veronika Papp 31, Theodore Rokkas 32, Dmitry S. Bordin 13, Sinead Smith 33, Juozas Kupcinskas 12, Lyudmila Boyanova 34, Antonio Gasbarrini 35, Marcis Leja 36, Ramón Pajares Villarroya 37, Irene Arteagoitia 38, Manuel Jiménez-Moreno 39, Anna Cano-Catala 40, Pablo Parra 5, Olga P. Nyssen 5, Francis Mégraud 41, Colm O'Morain 42, Leticia Moreira Ruiz 1, Javier P. Gisbert 5

Affiliations

1 Department of Gastroenterology, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelon

2 Department of Gastroenterology and Endoscopy, Gastromedica GM, Novi Pazar, Serbia

3 Department of Gastroenterology, Ferencváros Health Center, Budapest, Hungary

4 Department of Gastroenterology, Hospital Universitario Costa del Sol, Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Marbella, Spain

5 Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain

6 Athens Medical Centre, Paleo Faliron Hospital, Piraeus, Greece

7 Kazan (Volga Region) Federal University, Kazan State Medical University, Kazan, Russian Federation

8 Clinical Medicine, Trinity College Dublin, Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland

9 Mechnikov North-Western State Medical University, St. Petersburg, Russian Federation

10 Department of Gastroenterology, SM-Clinic, Saint-Petersburg, Russian Federation

11 Modern Hospital, Baku, Azerbaijan

12 Lithuanian University of Health Sciences, Kaunas, Lithuania

13 A.S. Loginov Moscow Clinical Scientific Center, Moscow, Russian Federation

14 University Hospital of Split, Split, Croatia

15 Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel

16 First Clinical Medical Centre, Kovrov, Russian Federation

17 Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Zaragoza, Spain

18 Smolensk State Medical University, Smolensk, Russian Federation

19 Biodonostia Health Research Institute, Universidad del País Vasco (UPV/EHU), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), San Sebastián, Spain

20 Rostov State Medical University, Rostov-on-Don, Russian Federation

21 Clinical Centre of Nis, Nis, Serbia

22 University Hospital Tsaritsa Ioanna-ISUL, Sofia, Bulgaria

23 Hospital Universitario Río Hortega Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain

24 Saint-Petersburg State Budgetary Institution Healthcare City Policlinic 38, St.Petersburg, Russian Federation

25 Gastrocenter, Perm, Russia, Moscow, Russian Federation

26 University Federico II, Naples, Italy

27 Merkezi Klinik Xestexana, Baku,, Azerbaijan

28 Hospital General de Tomelloso. Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM),

29 Azerbaijan State Advanced Training Institute for doctors named after A.ALIYEV, Baku, Azerbaijan

30 Clinical Centar of Serbia, Belgrade University, Belgrade, Serbia

31 Semmelweis University, Biatorbágy, Hungary

32 Henry Dunant Hospital, Athens, Greece

33 Trinity College Dublin, Dublin, Ireland

34 Department of Medical Microbiology, Medical University of Sofia, Sofia, Bulgaria

35 Fondazione Policlinico Universitario Gemelli IRCCS, Università’ Cattolica, Rome, Italy

36 Digestive Diseases Centre, Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia

37 Hospital Universitario Infanta Sofía Faculty of Medicine, Universidad Europea de Madrid, Madrid, Spain

38 Hospital Universitario de Cruces, Vizcaya, Spain

39 Hospital Universitario de Burgos, Burgos, Spain

40 Gastrointestinal Oncology, Endoscopy and Surgery (GOES) Research Group, Althaia Xarxa Assistencial Universitària de Manresa, Institut de Recerca i Innovació en Ciències de la Vida i de la Salut de la Catalunya Central (IRIS-CC), Manresa, Spain

41 INSERM U1312 BRIC, Université de Bordeaux, Bordeaux, France

42 Trinity College Dublin - Faculty of Health Sciences, Trinity College Dublin; Dublin/IE, Dublin, Ireland

Summary

AI Generated

Analysis of less frequently prescribed Helicobacter pylori eradication regimens from the European Registry shows that only PPI-clarithromycin-metronidazole-bismuth quadruple therapy and hybrid clarithromycin-amoxicillin-metronidazole regimens achieved first-line eradication rates above 90%, while effectiveness in subsequent treatment lines was highly variable and often suboptimal.

Among 82,510 prescriptions in the Hp-EuReg registry, 260 less frequently prescribed regimens (5.5%) were identified, with 2,853 (63%) used as first-line therapy.
In first-line treatment, bismuth-containing quadruple therapy with PPI-clarithromycin-metronidazole-bismuth achieved 90.5% per-protocol effectiveness, and hybrid quadruple therapy with clarithromycin-amoxicillin-metronidazole achieved 94.2% per-protocol effectiveness.
Second-line triple therapy with PPI-amoxicillin-moxifloxacin showed 91.8% effectiveness, while PPI-clarithromycin-levofloxacin and PPI-metronidazole-levofloxacin achieved 76.7% and 75% effectiveness respectively.
Third-line regimens demonstrated reduced effectiveness, with PPI-metronidazole-doxycycline-bismuth achieving 63.3% per-protocol effectiveness, PPI-clarithromycin-levofloxacin 50%, and PPI-amoxicillin-moxifloxacin 63.3%.
Antibiotic-free regimens combining PPI with probiotics were prescribed in 104 cases, with PPI plus Lactobacillus bulgaricus achieving 87.3% effectiveness but PPI plus Lactobacillus reuteri only 40.9% effectiveness.

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Abstract

Introduction

Despite the availability of clinical guidelines, a wide range of alternative Helicobacter pylori (H. pylori) eradication regimens continue to be used in routine clinical practice. Data on the frequency and effectiveness of these less frequently prescribed regimens remain limited.

Aims & Methods

Aim: To evaluate the prescription patterns and effectiveness of less frequently prescribed eradication regimens within the European Registry on Helicobacter pylori Management (Hp-EuReg).
Methods: International, multicentre, prospective, non-interventional registry on the management of H. pylori infection, ongoing since 2013. For this analysis, treatment regimens prescribed in fewer than 5% of all cases were classified as 'less frequently prescribed'. Additionally, therapies not previously categorized in the registry database were also included. Treatment effectiveness was assessed using modified intention-to-treat (mITT) and per-protocol (PP) analyses.

Results

Overall, 260 less frequently prescribed regimens were identified, representing 5.5% of all recorded prescriptions (82,510). A total of 2,853 (63%) of these regimens were used as first-line therapy. Among these less frequently prescribed regimens, the most frequently used first-line treatments encompassed bismuth-containing quadruple therapy with PPI–clarithromycin–metronidazole–bismuth (20%), followed by non-bismuth hybrid quadruple therapy with clarithromycin–amoxicillin–metronidazole (9.5%), and dual therapy with PPI–amoxicillin (8.6%). In second-line, the most common regimens were triple therapies, such as the PPI–amoxicillin–moxifloxacin (16%), PPI–clarithromycin–levofloxacin (11%), and PPI–metronidazole–levofloxacin (9.5%). In third-line, the most frequently used regimes were bismuth-based quadruple regimens including PPI–metronidazole–doxycycline–bismuth (27%), followed by triple therapies with PPI–clarithromycin–levofloxacin (6.8%) and PPI–amoxicillin–moxifloxacin (5.6%). In the fourth-line, the most frequent prescriptions were: bismuth-based quadruple therapies including PPI–amoxicillin–rifabutin–bismuth (30%) and PPI–metronidazole–doxycycline–bismuth (11%). Finally, the fifth treatment-line accounted for some less common treatments, such as the dual therapy with PPI–amoxicillin (19%) and the triple therapy with PPI–amoxicillin–bismuth (18%). Effectiveness and frequency of use in first-, second- and third-line of treatment are described in Table 1. Antibiotic-free regimens such as the combination of a PPI with a probiotic —generally Lactobacillus bulgaricus or Lactobacillus reuteri—were prescribed as alternative therapeutic approaches in 104 cases (2.3%), achieving 74% mITT and 76% PP overall effectiveness.

Table 1. Frecuency of use and effectiveness of alternative and infrequent prescriptions in first-, second- and third-line treatments.
		Frequency, n (%)	Effectiveness mITT	Effectiveness PP
Overall	Quadruple-PPI+C+M+B Dual-PPI+A Quadruple-PPI+M+D+B	597 (13.2) 339 (7.5) 309 (6.8)	90.4% 70.8% 67.1%	90.7% 70.8% 67.7%
First-line	Quadruple-PPI+C+M+B Hybrid-PPI+C+A+M Dual-PPI+A	580 (20.3) 270 (9.5) 244 (8.6)	90.2% 94.2% 76.1%	90.5% 94.2% 76.1%
Second-line	Triple-PPI+A+Mx Triple-PPI+C+L Triple-PPI+M+L	153 (15.8) 104 (10.7) 92 (9.5)	91.8% 76.9% 75%	91.8% 76.7% 75%
Third-line	Quadruple-PPI+M+D+B Triple-PPI+C+L Triple-PPI+A+Mx	106 (26.8) 27 (6.8) 22 (5.6)	62.7% 52% 63.3%	63.3% 50% 63.3%
Antibiotic free-regimens	PPI+Lactobacillus bulgaricus PPI+Lactobacillus reuteri	55 (52.8) 22 (21.15)	87.3% 40%	87.3% 40.9%
n, number of patients receiving a prescription; C, clarithromycin; M, metronidazole; B, bismuth; A, amoxicillin; D, doxycycline; L, levofloxacin; Mx, moxifloxacin; R, rifabutin; PPI, proton pump inhibitor; mITT, modified intention to treat; PP, per protocol.

Conclusion

Among the various less frequently used H. pylori eradication regimens, only a few (such as the PPI-clarithromycin-metronidazole-bismuth regimen and the hybrid regimen including clarithromycin–amoxicillin–metronidazole) achieved first-line eradication rates above 90%. In subsequent treatment lines, effectiveness was highly variable and often suboptimal. These findings highlight the importance of evidence-based treatment selection to optimize treatment outcomes.

Disclosure

Conflict of interest statement
Olga P. Nyssen has served as a speaker or has received research funding from Allergan, Mayoly Spindler, Richen, Biocodex and Juvisé.
Javier P. Gisbert has served as speaker, consultant, and advisory member for or has received research funding from Mayoly, Allergan/Abbvie, Diasorin, Richen, Juvisé, Biocodex.
The remaining authors declare no conflicts of interest.

Conference

UEG Week Berlin 2025

Topics

Stomach & H. Pylori

Submission format

Abstract

Session

H. pylori: Real world data (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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THERAPEUTIC POTENTIAL OF PROBIOTICS IN DNBS-INDUCED COLITIS: IMMUNOLOGICAL AND MICROBIAL INSIGHTS

Pakkapon Rattanachaisit 1, Nathawadee Lerttanatum 1, Somying Tumwasorn 1, Natthaya Chuaypen 1, Thasinas Dissayabutra 1, Duangporn Werawatganon 1

Affiliations

1 Chulalongkorn University, Bangkok, Thailand

Summary

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Abstract

Introduction

Inflammatory bowel disease is a chronic, relapsing condition influenced by genetic, microbial, and environmental factors. This study evaluated the therapeutic potential of multi-strain probiotics in mitigating the severity of experimentally induced colitis in rats, focusing on clinical outcomes, histopathological changes, inflammatory markers, and microbiota changes.

Aims & Methods

Thirty six-week-old male Sprague-Dawley rats were randomly assigned to three groups: Control, Acute Colitis (AC), and Probiotic Treatment (RP; receiving Lactobacillus rhamnosus and Lactobacillus paracasei). Probiotics were administered orally once daily, beginning three days prior to colitis induction with rectal DNBS and continued for seven days post-induction. On day eight, colon tissues and blood samples were collected for histological and biochemical analysis, and fecal samples were analyzed to assess gut microbiota composition.

Results

The AC group showed significantly elevated TNF-α levels compared to the Control and RP groups (p < 0.001), while probiotic treatment significantly reduced TNF-α levels compared to the AC group (p = 0.002, p < 0.001, respectively). Although the RP group demonstrated increased IL-10 levels and decreased MDA levels, these changes were not statistically significant. Histopathological analysis revealed a lower median Ameho’s score in the RP group compared to the AC group, though without statistical significance.

Microbiota analysis showed no significant differences in alpha diversity across groups. However, beta diversity significantly differed in the AC group compared to Control, and after probiotic treatment, the RP group’s beta diversity showed a partial shift toward the Control group. Distinct microbial species characterized each group: Akkermansia spp. and Parasutterella spp. were predominant in distinguishing the Control group from others; Romboutsia spp. and Turicibacter spp. differentiated the AC group; and Roseburia spp. and Anaerotruncus spp. were the key species distinguishing the RP group from the others.

	Control	AC	RP
TNF-α (pg/ml)	3240 (2185-3852.5)	10950 (5880-16275)	3505 (2342.5-4762.5)
IL-10 (pg/ml)	313 (170.5-528.25)	199 (111.2-522.75)	324 (248.5-445.25)
MDA (nmol/mg protein)	(1.69-12.84)	9 (2.44-25.54)	4 (2.38-20.78)
IL-17 (pg/ml)	121 (118.25-159.75)	128 (121-151.75)	127 (121.75-129.25)
Ameho's score	0	5 (1-5)	1 (1-3.5)

Conclusion

Multi-strain probiotics reduced TNF-α levels and modulated gut microbiota composition in DNBS-induced colitis. Although changes in IL-10, MDA, and histopathology were not statistically significant, trends favored the probiotic group. Microbial analysis revealed distinct species profiles across groups, with partial restoration of beta diversity and enrichment of beneficial taxa like Roseburia spp. in the probiotic group. These findings support the potential of probiotics as a therapeutic adjunct in IBD, highlighting the need for further studies to confirm efficacy and explore underlying mechanisms.

Conference

UEG Week Berlin 2025

Topics

IBD

Submission format

Abstract

Session

IBD (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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PRESCRIPTIONS AND EFFECTIVENESS OF ALTERNATIVE AND INFREQUENT HELICOBACTER PYLORI ERADICATION REGIMENS: INSIGHTS FROM THE EUROPEAN REGISTRY ON H. PYLORI MANAGEMENT (HP-EUREG)

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