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EFFECTIVENESS OF SINGLE-CAPSULE BISMUTH QUADRUPLE RE-TREATMENT AFTER PREVIOUS FAILURE WITH THE SAME THERAPY: RESULTS FROM THE EUROPEAN REGISTRY ON HELICOBACTER PYLORI MANAGEMENT (HP-EUREG)

Olga P. Nyssen 1, Manuel Pabon-Carrasco 2, Manuel Castro-Fernández 2, Samuel J Martínez-Domínguez 3, Alma Keco-Huerga 2, Alfredo J. Lucendo 4, Eduardo Iyo 5, Georges Kamtoh 6, Tamara Matysiak-Budnik 7, Inmaculada Ortiz Polo 8, Luis Ricardo Rodrigo Sáez 9, Blas José Gómez-Rodríguez 10, Sheyla Montori 11, Enrique Alfaro Almajano 3, Kateryna Priadko 7, Miguel Suárez Matías 12, S. Gil Rojas 12, Matteo Pavoni 13, Giulia Fiorini 14, Rosa Rosania 15, Riccardo Vasapolli 16, Ana Garre 1, Ángeles Pérez-Aísa 17, Jesús Barrio 18, M. Soledad Marcos 19, Ramón Pajares Villarroya 20, Jose Xavier Segarra Ortega 21, Antonio Moreno 22, Oliver Patrón 23, Diego Burgos-Santamaría 24, VIRGINIA FLORES 25, Antonio Gasbarrini 26, Marco Romano 27, Antonietta Gerarda Gravina 28, Piotr Szredzki 29, Michael Doulberis 30, Mónica Sánchez Alonso 31, Jose Maria Huguet 32, Javier Tejedor-Tejada 33, Eduardo Albéniz-Arbizu 11, Manuel Jiménez-Moreno 34, Luis Hernández Villalba 34, Wojciech Marlicz 35, Marino Venerito 15, Anna Cano Català 36, Pablo Parra 1, Leticia Moreira Ruiz 37, Francis Mégraud 38, Colm O'Morain 39, Javier P. Gisbert 1

Affiliations

1 Department of Gastroenterology, Hospital Universitario de La Princesa, IIS-Princesa, Universidad Autónoma de Madrid (UAM), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain

2 Department of Gastroenterology, Hospital Universitario Virgen de Valme, Sevilla, Spain

3 Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Zaragoza, Spain

4 Department of Gastroenterology, Hospital General de Tomelloso, IIS-Princesa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Tomelloso, Spain

5 Department of Gastroenterology, Hospital Comarcal de Inca, Inca, Spain

6 Hepatic Medical, Private Medical Center, Krakow, Poland

7 Hepato-Gastroenterology & Digestive Oncology Unit, University Hospital of Nantes, Nantes, France

8 Department of Gastroenterology, Hospital Universitario y Politécnico La Fe, Valencia, Spain

9 Department of Gastroenterology, Universidad de Oviedo, Oviedo, Spain

10 Department of Gastroenterology, Hospital Universitario Virgen Macarena, Sevilla, Spain

11 Department of Gastroenterology, Hospital Universitario de Navarra, Navarrabiomed, Universidad Pública de Navarra, Pamplona, Spain

12 Department of Gastroenterology, Hospital Virgen de la Luz, Cuenca, Spain

13 Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi University Hospital, Bologna, Italy

14 IRCCS Azienda Ospedaliero-Universitaria di Bologna, Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy

15 Department of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke University Hospital, Magdeburg, Germany

16 Medical Department 2, University Hospital LMU Munich, Munich, Germany

17 Department of Gastroenterology, Hospital Universitario Costa del Sol, Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Marbella, Spain

18 Department of Gastroenterology, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain

19 Department of Gastroenterology, Hospital 12 de Octubre, Madrid, Spain

20 Department of Gastroenterology, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain

21 Department of Gastroenterology, Hospital Universitario de Salamanca, Grupo de Investigación Salmantino en Aparato Digestivo (GISAD), Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain

22 Department of Gastroenterology, Hospital Universitario Virgen del Rocío, Sevilla, Spain

23 Department of Gastroenterology, Hospital Parque Llevant, Manacor, Spain

24 Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Madrid, Spain

25 Department of Gastroenterology, Hospital General Universitario Gregorio Marañón, Madrid, Spain

26 Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy

27 Department of Gastroenterology and Endoscopy, Department of Precision Medicine, Università Vanvitelli, Napoli, Italy

28 Department of Hepato-Gastroenterology, University of study of Campania "L. Vanvitelli", Napoli, Italy

29 Department of Gastroenterology, Hospital John Paul II City Hospital, Rzeszow, Poland

30 Department of Gastroenterology, Kantonsspital Aarau, Aarau, Switzerland

31 Department of Gastroenterology, Hospital Universitario Santa Bárbara, Puertollano, Spain

32 Department of Gastroenterology, Hospital General Universitario de Valencia, Valencia, Spain

33 Department of Gastroenterology, Hospital Universitario de Cabueñes, Gijón, Spain

34 Department of Gastroenterology, Hospital Santos Reyes, Aranda de Duero, Spain

35 Department of Gastroenterology, Pomeranian Medical University in Szczecin, The Centre for Digestive Diseases, Endoklinika, Szczecin, Poland

36 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

37 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

38 INSERM U 1312, Université de Bordeaux, Bordeaux, France

39 School of Medicine, Trinity College Dublin, Dublin, Ireland

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Abstract

Introduction

The effectiveness of H. pylori treatment decreases as eradication failures accumulate; however, bismuth quadruple therapy with the single-capsule has shown optimal results not only in first but also in second and subsequent lines of treatment, even in patients with dual clarithromycin and metronidazole resistant strains.

Aims & Methods

To evaluate the use and effectiveness of the single-capsule bismuth quadruple therapy when empirically prescribed as retreatment, despite one or multiple previous eradication failures with the same treatment.
All patients registered at e-CRF AEG-REDCap as part of the European Registry on H. pylori management (Hp-EuReg) from 2013 to 2023, who had received single-capsule therapy in at least 2 different treatment lines (not necessarily consecutive), were analyzed.

Results

Out of 2,579 patients treated with the single-capsule from 2^nd to 6^th rescue treatment line, 101 cases received again the same single-capsule therapy at least in 2 different treatment lines: 67 re-treatments in 2^nd line having previously failed in 1^st line with the single-capsule; 16 re-treatments in 3^rd line (of which 12 had previously received this same therapy in 2^nd line); 11 in 4^th line (previously having failed the same therapy in either 1^st , 2^nd or 3^rd line); 4 in 5^th line; and further 3 in 6^th line (Table). The effectiveness of bismuth quadruple therapy as single-capsule when empirically prescribed repeatedly in 2^nd line was over 90%, and achieved almost 80% in all cases retreated in 3^rd line.

Table. Use of bismuth quadruple rescue therapy as single-capsule when prescribed empirically after previous failure(s) with the same therapy.
N: total number of patients analysed; n/N: patients with a successful eradication/total number of patients analysed.
Previous failed line, N *1^st line* *2^nd line* *3^rd line* *4^th line* Total number of cases re-treated	2^nd line 67 0 0 0 67	3^rd line 4 12 0 0 16	4^th line 3 5 3 0 11	5^th line 0 1 1 2 4	6^th line 0 1 0 2 3
Effectiveness by modified intention-to-treat of bismuth quadruple rescue therapy as single-capsule when prescribed empirically after previous failure(s) with the same therapy.
Previous failed line, %, (n/N) *1^st line* *2^nd line* *3^rd line* *4^th line* Overall	2^nd line 94% (62/66) 94% (62/66)	3^rd line 75% (3/4) 80% (8/10) 79% (11/14)	4^th line 100% (2/2) 75% (3/4) 67% (2/3) 78% (7/9)	5^th line 100% (1/1) 100% (1/1) 50% (1/2) 75% (3/4)	6^th line 100% (2/2) 100% (2/2)

Conclusion

The empirical administration of bismuth quadruple therapy as single-capsule when prescribed as re-treatment in 2^nd line after previous failure with the same therapy achieves optimal effectiveness (>90%).

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.

Conference

UEG Week Vienna 2024

Topics

Stomach & H. Pylori

Submission format

Abstract

Session

H.pylori treatment: Part 2 (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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