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UEG Presentation

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IMPACT OF PROBIOTICS USE ON THE SAFETY OF HELICOBACTER PYLORI TREATMENTS: RESULTS OF THE EUROPEAN REGISTRY ON THE MANAGEMENT OF HELICOBACTER PYLORI INFECTION (HP-EUREG)

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Introduction

Clinical practice data on utility of probiotics (PB) to prevent adverse effects (AEs) associated with treatment of H pylori infection are scarce.

Aims & Methods

Aims: To assess the usefulness of PB use in improving the safety of eradication therapies used in Europe.
Methods: Prospective, multicentre, non-interventional registry (Hp-EuReg) of the clinical practice of European gastroenterologists. Data were collected in an e-CRD in AEG-REDCap from 2013 to 2021. Information was included from countries with at least 30 cases undergoing eradication therapy and at least 1 with associated PB, with controls being patients without PB. AEs were categorised as mild, moderate and severe. Results were grouped by region. A modified intention-to treat analysis and a logistic regression model, considering age, sex, duration and regimen of eradication treatment, PPI dose and adherence were performed.

Results

36,699 patients were included; 8,233 (22%) treated with PB. Multiple PB formulations were used, including 9 genera and 32 species. In the PB group the rate of overall AEs was higher (25% vs 22%, p<0.0001), but the rate of severe AEs was lower (1.9% vs 1.1%, p<0.0001). The duration of AE's was shorter in the PB group (6.4 vs 8.2 days, p<0.0001). The logistic regression model was applied to data from the Central European region as it has the highest frequency of PB use and, therefore, the lowest risk of prescription driven by expected AEs. In this model, PB use was associated with a lower incidence of both global and severe AEs. In terms of genus, with Bifidobacterium the incidence of at least one AE and that of severe AEs was lower (p=0.0019 and p<0.001, respectively), while Lactobacillus only had benefit for the incidence of severe AEs associated with triple therapy (p=0.0278) and Bacillus showed inconsistent results.

Conclusion

The use of PB was associated with a lower incidence of AEs, as well as shorter duration and severity of AEs. The genus Bifidobacterium may be the most useful in the prevention of AEs.

IMPACT OF PROBIOTICS USE ON THE SAFETY OF HELICOBACTER PYLORI TREATMENTS: RESULTS OF THE EUROPEAN REGISTRY ON THE MANAGEMENT OF HELICOBACTER PYLORI INFECTION (HP-EUREG)

Diego Casas Deza 1, Javier Alcedo 1, Miguel Lafuente 2, F. Javier Lopez 2, Ángeles Pérez-Aísa 3, Matteo Pavoni 4, Ilaria Maria Saracino 5, Bojan Tepes 6, Laimas Virginijus Jonaitis 7, Manuel Castro-Fernández 8, Manuel Pabon-Carrasco 8, Alma Keco-Huerga 8, Irina Voynovan 9, Luis Bujanda Fernández de Piérola 10, Alfredo J. Lucendo 11, Natasa Brglez Jurecic 12, Maja Denkovski 12, Perminder S. Phull 13, Luis Ricardo Rodrigo Sáez 14, Angel Lanas 15, Samuel Jesús Martínez-Domínguez 15, Jose Maria Huguet 16, Dmitry S. Bordin 17, Antonio Gasbarrini 18, Juozas Kupcinskas 7, Gülüstan Babayeva 19, Oleksiy Gridnyev 20, Marcis Leja 21, Theodore Rokkas 22, Ricardo Pinto 23, Frode Lerang 24, Doron Boltin 25, Veronika Papp 26, ANTE TONKIC 27, Sinead M. Smith 28, Halis Simsek 29, Marino Venerito 30, Lyudmila Boyanova 31, Vladimir Milivojevic 32, Lumir Kunovsky 33, Tamara Matysiak-Budnik 34, Wojciech Marlicz 35, Michael Doulberis 36, Anna Cano-Catala 37, Luis Hernández Villalba 38, Leticia Moreira Ruiz 39, Olga P. Nyssen 40, Francis Mégraud 41, Colm O'Morain 28, Javier Gisbert 40

1 Miguel Servet University Hospital, Zaragoza, Spain|||Aragon Health Research Institute (IIS Aragon), Zaragoza, Spain

2 University of Zaragoza, Zaragoza, Spain|||Institute for Biocomputation and Physics of Complex Systems (BIFI), University of Zaragoza, Zaragoza, Spain

3 Agencia Sanitaria Costa del Sol, Marbella, Málaga, Spain

4 IRCCS St. Orsola Polyclinic, University of Bologna, Bologna, Italy|||University of Bologna, Bologna, Italy

5 IRCCS St. Orsola Polyclinic, University of Bologna, Bologna, Italy

6 DC Rogaska, Rogaska Slatina, Slovenia

7 Lithuanian University of Health Sciences, Kaunas, Lithuania

8 Valme University Hospital, Sevilla, Spain

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

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

11 Tomelloso General Hospital, Tomelloso, Ciudad Real, Spain|||Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain|||La Princesa Health Research Institute, Madrid, Spain

12 Interni Oddelek Diagnostic Centre Bled, Bled, Slovenia

13 Aberdeen Royal Infirmary, Aberdeen, United Kingdom

14 University of Oviedo, Oviedo, Spain

15 Hospital Clínico Lozano Blesa, Zaragoza, Spain|||Aragon Health Research Institute (IIS Aragon), Zaragoza, Spain|||Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain

16 University General Hospital of Valencia, Valencia, Spain

17 A.S. Loginov Moscow Clinical Scientific Center, Moscow, Russian Federation|||A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation|||Tver State Medical University, Tver, Russian Federation

18 Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy

19 Azerbaijan State Advanced Training Institute for Doctors named by A. Aliyev, Baku, Azerbaijan

20 L. T. Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine

21 Gastro, Digestive Diseases Centre, Riga, Latvia|||University of Latvia, Riga, Latvia

22 Henry Dunant Hospital, Athens, Greece

23 Centro Hospitalar do Porto, Porto, Portugal|||Universidade do Porto, Porto, Portugal|||Center for Research in Health Technologies and Information Systems (CINTESIS), Porto, Portugal

24 Østfold Hospital Trust, Grålum, Norway

25 Rabin Medical Center, Petah Tikva, Tel Aviv, Israel|||Tel Aviv University, Tel Aviv, Israel

26 Semmelweis University, Budapest, Hungary

27 University Hospital of Split, Split, Croatia

28 Trinity College Dublin, Dublin, Ireland

29 Hacettepe University, Ankara, Turkey|||HC International Clinic, Ankara, Turkey

30 University Hospital of Magdeburg, Magdeburg, Germany

31 Medical University of Sofia, Sofia, Bulgaria

32 Clinical Center of Serbia, Belgrade, Serbia|||University of Belgrade, Belgrade, Serbia

33 University Hospital Olomouc, Olomuc, Czechia|||Palacky University Olomouc, Olumuc, Czechia|||University Hospital Brno, Brno, Czechia|||Masaryk University, Brno, Czechia|||Masaryk Memorial Cancer Institute, Brno, Czechia

34 University Hospital of Nantes, Nantes, France

35 Pomeranian Medical University in Szczecin, Szczecin, Poland|||The Centre for Digestive Diseases, Endoklinika, Szczecin, Poland

36 Kantonsspital Aarau, Aarau, Switzerland

37 Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, Spain

38 Hospital Santos Reyes, Aranda de Duero, Burgos, Spain

39 Hospital Clínic de Barcelona, Barcelona, Spain|||Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain|||University of Barcelona, Barcelona, Spain

40 La Princesa University Hospital, Madrid, Spain|||La Princesa Health Research Institute (IIS-Princesa), Madrid, Spain|||Universidad Autónoma de Madrid (UAM), Madrid, Spain|||Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (C

41 Université de Bordeaux, Bordeaux, France

Event

UEG Week Copenhagen 2023

Topics

Digestive Oncology Gut Microbiota Stomach & H. Pylori

Submission format

Abstract

Session

H. pylori: From disease pathway to therapy

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Presentation

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A HEALTHY LIFESTYLE IS PROSPECTIVELY ASSOCIATED WITH REDUCED RISK OF NON-ALCOHOLIC FATTY LIVER DISEASE, INSULIN RESISTANCE, AND MARKERS OF SIGNIFICANT FIBROSIS AND STEATOHEPATITIS

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Introduction

Non-alcoholic fatty liver disease (NAFLD) is associated with unhealthy lifestyle habits and diet. However, there is limited prospective evidence on the combined association of those factors and NAFLD, with no data regarding insulin resistance (IR), fibrosis, and steatohepatitis markers.

Aims & Methods

We aimed to test the association between a combination of lifestyle components, expressed as a healthy lifestyle index (HLI), with the incidence of NAFLD, IR, fibrosis, and steatohepatitis.
A prospective cohort study among volunteers who participated in a metabolic and hepatic screening survey, and follow-up evaluation at Tel-Aviv Medical Center. NAFLD was evaluated by ultrasonography or controlled attenuation parameter (CAP) at two-time points to evaluate incidence, persistence or remission, and IR was evaluated by homeostasis model assessment. Presumed fibrosis and non-alcoholic steatohepatitis were evaluated non-invasively by FibroMax serum biomarkers. HLI was calculated as the sum of four lifestyle components (ranging from 0 to 4 points): lifetime non-smoking, healthy weight, healthy dietary pattern, and routine performance of physical activity.

Results

The final sample included 315 subjects, 40-70 years old, 56.8% men, and 18.3% with incident NAFLD. The mean follow-up was 6.66±0.73 years. In multivariable analyses, a favorable lifestyle (≥3 healthy lifestyle components) was independently associated with a lower risk for incident NAFLD (OR=0.42; 95%CI 0.19-0.90; P=0.026). Similarly, a favorable lifestyle was associated with lower odds of new-onset/persistence (versus never or remission) of NAFLD and IR, respectively (OR=0.49; 95%CI 0.30-0.80; P=0.004; OR=0.40; 95%CI 0.24-0.66; P<0.001), with a dose-response association in univariate analysis (P for trend <0.001 for NAFLD, and P<0.001 for IR), and similar trend in multivariable analysis. In addition, a favorable lifestyle was associated with a lower risk for incident steatohepatitis on its own or combined with significant fibrosis (≥F2), respectively (OR=0.50; 95%CI 0.27-0.95; P=0.035; OR=0.45; 95%CI 0.24-0.85; P=0.014).

Conclusion

Adherence to a healthy lifestyle is associated with reduced risk of NAFLD, markers of significant fibrosis and steatohepatitis, and IR. A holistic approach taking into consideration the combination of lifestyle behaviors may be more useful for preventing NAFLD and related liver damage.