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EMPIRICAL ERADICATION THERAPY FOR HELICOBACTER PYLORI INFECTION IN SECOND AND SUBSEQUENT TREATMENT LINES: EXPERIENCE FROM 500 CASES OF THE BRAZILIAN REGISTRY ON H. PYLORI MANAGEMENT (HP-BRAZILREG)

Bruno Sanches 1, Olga P. Nyssen 2, Sandro Chaves 1, Julio Cesar Veloso 3, James Marinho 4, Leonardo Soares da Silva drleonardoss 5, Hoiti Okamoto 6, Gustavo Couto 7, Helenice Breyer 8, CHRISTIANE ALENCAR 9, ERNESTO COMELLI 10, Luis Alberto Sobral Sousa 11, Mariana Horn 12, Maria Jose Massote 13, Marcela Loures 14, MARIA DE FÁTIMA PIETROLUONGO VIDAL 15, Rocival Paula 16, Laercio Ribeiro 17, Humberto Galizzi 18, Daniel Terra 19, Guilherme Cançado 20, Bibiana Burmann 21, Jardel Caetano 22, Luiz Pena 23, Mario Decanio 24, Heitor Siffert Pereira de Souza 25, Aline Kuniyoshi 26, Ludmila Guedes 27, Maria do Carmo Friche Passos 28, frederico passos marinho 20, Isadora Bombassaro 29, Aline Domingues 30, Jaques Garcia 31, Islaine Nogueira 32, Ana Ramos 33, DANIELLA KORMAN 19, Teogenes Souza 34, Moni Chiara Barbosa 35, Decio Chinzon 36, Leandro Lima da Silva 37, Augusto Montovani 38, Alzimara Hemerly Freitas 39, Christiane Poncinelli 40, Marcelo Francato 41, Jussiane Gonçalves 1, Pablo Parra 42, Anna Cano-Catala 43, Leticia Moreira Ruiz 44, Javier P. Gisbert 2, Luiz Coelho 1

Affiliations

1 Federal University of Minas Gerais, Belo Horizonte, Brazil

2 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

3 Hospital Santa Helena, Brasilia, Brazil

4 Universidade Estadual de Ciências da Saúde de Alagoas - UNCISAL, Maceio, Brazil

5 Hospital Adventista de Manaus, Manaus, Brazil

6 Oxford Medical Center, Sao Bento Sul, Brazil

7 Centro de Consultas Especializadas, Contagem, Brazil

8 Federal University of Rio Grande do Sul/Clinics Hospital, Porto Alegre, Brazil

9 Chrismed, Rio de Janeiro, Brazil

10 Clinica Castromed, Castro, Brazil

11 Coopeclin, Recife, Brazil

12 Clinica Endocentro, Florianopolis, Brazil

13 Unidade de Saude, Santos, Brazil

14 Hospita Nossa Senhora Das Graças, Curitiba, Brazil

15 Hospital Ana Costa, Santos, Brazil

16 Clinica Privada, Aracaju, Brazil

17 Hospital Universitário Prof. Alberto Antunes, Maceio, Brazil

18 Hepscan, Belo Horizonte, Brazil

19 Hospital Militar de Minas Gerais, Belo Horizonte, Brazil

20 Federal University of Minas Gerais/Clinics Hospital, Belo Horizonte, Brazil

21 Medplus, Porto Alegre, Brazil

22 Hospital São Rafael, Salvador, Brazil

23 Socor Hospital, Belo Horizonte, Brazil

24 Hospital Portugues, Salvador, Brazil

25 Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

26 Universidade Estadual de Maringá, Maringá, Brazil

27 Rede Mater Dei de Saúde, Belo Horizonte, Brazil

28 Hospital das Clinicas, UFMG, Belo Horizonte, Brazil

29 Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil

30 GRD GASTRO, Rio de Janeiro, Brazil

31 Santa Casa de Barretos, Barretos, Brazil

32 Clinica Privada, São Paulo, Brazil

33 Santa Casa de Misericordia de Belo Horizonte, Belo Horizonte, Brazil

34 Faculdades Integradas de Patos, Patos, Brazil

35 Clinica Privada, Arapiraca, Brazil

36 University of Sao Paulo, Sao Paulo, Brazil

37 Monte Sinai Hospital e Maternidade, Juiz de Fora, Brazil

38 Universidade do Vale do Rio dos Sinos, Porto Alegre, Brazil

39 Unimed Sul Capixaba, Cachoeiro do Itapemirim, Brazil

40 Biogastro, Belo Horizonte, Brazil

41 Hospital Municipal Antonio Giglio, Osasco, Brazil

42 Universidad Autónoma de Madrid, Madrid, Spain

43 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

44 Hospital Clinic de Barcelona, Gava, Spain

Summary

AI Generated

A Brazilian multicenter registry of 572 patients evaluated effectiveness of empirical second-line and subsequent Helicobacter pylori therapies, finding suboptimal second-line cure rates overall but identifying several regimens with high effectiveness in rescue treatment.

Second-line therapy achieved 74% overall eradication rate, with the most common regimen (PPI-amoxicillin-levofloxacin) reaching 84% effectiveness at 14 days but only 55% at 10 days.
Adding bismuth to 14-day PPI-amoxicillin-levofloxacin therapy increased effectiveness to 100% (p=0.016).
Third-line bismuth quadruple therapy with PPI-bismuth-tetracycline-metronidazole achieved 87% cure rate in 24% of patients.
Dual therapy with vonoprazan 20 mg BID plus amoxicillin achieved 100% eradication in fourth-line (33% of patients) and fifth-line and subsequent treatments (43% of patients).
Adverse events were mild and occurred in 23% of patients, with nausea most common (14%), and compliance was 99%.

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Abstract

Introduction

The effectiveness of anti-Helicobacter pylori treatment decreases as therapy failure accumulates. Different consensuses recommend knowing the regional performance of therapeutic regimens to achieve better eradication results in real clinical practice.

Aims & Methods

To evaluate the effectiveness of empirical therapy in second and subsequent treatment lines in Brazil.
Real-life, multicenter, prospective, non-interventional registry evaluating outcomes of H. pylori management by Brazilian gastroenterologists (Hp-BrazilReg, WorldHpReg’s partner). Data were registered at e-CRF AEG-RedCap from March 2022 to October 2024. The effectiveness was evaluated by modified intention-to-treat (mITT) analysis. Data were subject to quality review.

Results

572 patients, with a mean age of 52 years, 64% women, were evaluated. The main treatment indications were dyspepsia (64%) and gastroduodenal ulcer (9.2%). 386 (67%) patients received a second-line therapy, and 186 (32%) received third-line or subsequent therapy. Low-dose (between 4.5 and 27 mg of omeprazole equivalent BID), standard-dose (between 32 and 40 mg of omeprazole equivalent BID), and high-dose (between 54 and 128 mg of omeprazole BID) proton pump inhibitor (PPIs) were used in 40%, 10%, and 24%, respectively. Vonoprazan (VPZ) 20 mg BID, was used in 26% of cases. With the second-line treatment, the overall eradication rate was 74%. The most frequently used regimen was the triple therapy with PPI+amoxicillin+levofloxacin for 10-14 days, in 55% of the patients. This regimen, recommended as an alternative by the Brazilian Consensus, achieved an eradication rate of 84% (14 days) and 55% (10 days). By adding bismuth to this same 14-day regimen the effectiveness increased to 100% (p=0.016). Regarding the third-line, the regimen containing PPI-bismuth-tetracycline-metronidazole was used in 24% of the cases, achieving 87% mITT cure rate. Within the fourth-line, dual therapy including amoxicillin-VPZ was the most common regimen (33%), achieving 100% eradication, followed by bismuth quadruple therapy with PPI+bismuth+amoxicillin+rifabutin (14%), showing 100% effectiveness. Dual therapy with VPZ+amoxicillin was also the most used regimen in the fifth-line and subsequent treatment lines, encompassing 43% of the cases, and achieving also 100% effectiveness. Overall, 23% of the patients presented mild adverse events being nausea the most frequent (14%), and compliance was 99%.

Conclusion

In Brazil, the overall effectiveness of second-line therapy showed suboptimal (≤90%) cure rate; however, the combination of bismuth-amoxicillin-levofloxacin prescribed for 14 days reported successful effectiveness. In the third-line, the classical bismuth-quadruple therapy with metronidazole-tetracycline provided encouraging results (87%). Alternatively, dual therapy with VPZ and amoxicillin and rifabutin-based bismuth quadruple therapy showed promising results in third- and fifth-line rescue treatment.

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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Building a bile duct: What can structural tissue patterning tell us about liver disease?

Luke Boulter 1

Affiliations

1 University of Edinburgh, Edinburgh, United Kingdom

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Abstract

Event

UEG Week Berlin 2025

Topics

Hepatobiliary Mechanisms & Personalised Medicine

Session

The art of making clinical research precise: Narrowing the gap between the bench and bedside

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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UEG Presentation

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LONG-TERM PROTON PUMP INHIBITOR USE AND RISK OF GASTRIC NEUROENDOCRINE NEOPLASMS IN A POPULATION-BASED STUDY FROM THE FIVE NORDIC COUNTRIES

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LONG-TERM PROTON PUMP INHIBITOR USE AND RISK OF GASTRIC NEUROENDOCRINE NEOPLASMS IN A POPULATION-BASED STUDY FROM THE FIVE NORDIC COUNTRIES

Eivind Ness-Jensen 1, Giola Santoni 2, Cecilia Radkiewicz 2, My von Euler-Chelpin 3, Joonas H. Kauppila 4, Helgi Birgisson 5, Reidar Fossmark 6, Jesper Lagergren 7

Affiliations

1 NTNU, Norwegian University of Science and Technology, Levanger, Norway|||Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger, Norway

2 Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden

3 University of Copenhagen, Copenhagen, Denmark

4 University of Oulu and Oulu University Hospital, Oulu, Finland|||Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden

5 Icelandic Cancer Registry, Reykjavík, Iceland

6 NTNU, Norwegian University of Science and Technology, Trondheim, Norway|||Oslo University Hospital, Oslo, Norway

7 King's College London and Guy’s and St Thomas Foundation Trust, London, United Kingdom|||Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden

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Abstract

Introduction

Hypergastrinemia, caused by chronic atrophic gastritis or Helicobacter pylori (H. pylori) associated pangastritis, is associated with an increased risk of non-cardia gastric cancer. Recent studies have also found an increased risk of gastric cancer in long-term proton pump inhibitor (PPI) users. Patients with chronic atrophic gastritis also have an increased risk of neuroendocrine neoplasms (NEN) due to hypergastrinemia. However, whether long-term PPI use increases the risk of gastric NEN has not been assessed in the general population.

Aims & Methods

The aim of the present study was to assess the risk of gastric NEN among long-term PPI users in a multinational population-based study from the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden). The study was based on the Nordic Gastric and Esophageal Tumor Study (NordGETS), which is a population-based multinational sex, age, calendar year, and country matched case-control study including all adults (≥18 years of age) with a diagnosis of gastric or esophageal tumor in the Nordic countries. In the present study, the cases were incident gastric NEN identified in the cancer registries and the exposure was long-term use of PPI categorised into three equal-sized groups (tertiles) of defined daily doses (DDDs) from the medication registries of the Nordic countries between 1996 and 2020. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for chronic atrophic gastritis, NEN in the duodenum or pancreas, and H. pylori infection identified in the patient registries and medication registries.

Results

In total, 1,790 gastric NEN case patients were compared to 17,897 control participants. After a one-year run-in period, the median follow-up was 11.8 years. The risk of incident gastric NEN increased in PPI users compared to non-users in a dose-dependent manner. The adjusted OR for incident gastric NEN was 1.83 (95% CI 1.56 to 2.15) in the highest tertile of PPI use (>385 DDDs, entire drug history) compared to no PPI use (Table). The risk was higher in the younger age group (<65 years) than the older age group (≥65 years) and the estimates were consistent when excluding individuals with chronic atrophic gastritis, other NENs, and H. pylori.

Table Risk of gastric neuroendocrine neoplasms (NEN) by proton pump inhibitor (PPI) exposure defined by tertiles of defined daily doses (DDD) for the entire drug history between 1996 and 2020.
PPI (DDD)*	Crude odds ratio (95% confidence interval)**	Adjusted odds ratio (95% confidence interval)***
None	1.00 (reference)	1.00 (reference)
Tertile 1	1.46 (1.25-1.70)	1.34 (1.14-1.58)
Tertile 2	1.54 (1.30-1.81)	1.37 (1.15-1.64)
Tertile 3	1.92 (1.65-2.24)	1.83 (1.56-2.15)
* Tertiles: 1 ≤56 DDDs; 2 >56-385 DDDs; 3 >385 DDDs. Matched for sex, age, calendar year, and country. * Matched for sex, age, calendar year, and country, and adjusted for chronic atrophic gastritis, NEN in duodenum or pancreas, and H. pylori.

Conclusion

In this population-based study from the five Nordic countries the risk of gastric NEN was increased in PPI users compared to non-users of PPI in a seemingly dose-dependent manner. The risk was higher in younger age groups of PPI users compared to older age groups.

Disclosure

No conflicts of interest

Event

UEG Week Berlin 2025

Topics

Digestive Oncology Endoscopy Oesophagus

Submission format

Abstract

Session

From prediction to detection in upper GI

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Gastro-oesophageal reflux disease diagnosis and how to avoid them

Sabine Roman 1

Affiliations

1 Hôpital Edouard Herriot, Lyon, France

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Abstract

Event

UEG Week Berlin 2025

Topics

Endoscopy Nurses Small Intestine & Nutrition Oesophagus Surgery

Session

Mistakes in…: Upper GI

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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Whole diet interventions for IBS

Heidi Staudacher 1

Affiliations

1 The University of Queensland, Melbourne, Australia

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Abstract

Event

UEG Week Berlin 2025

Topics

IBD Neurogastroenterology & Motility Primary Care

Session

Diet and disorders of gut-brain interaction: From IBS to IBD

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Franco Radaelli

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THE CORRELATION BETWEEN STRESS AND AUTONOMIC NERVOUS SYSTEM RESPONSE IN GASTROINTESTINAL PATIENTS

AGATA FURGALA 1, Magdalena Przybylska-Felus 2, Ihor Kovalchuk 1, Krzysztof Gil 1, Małgorzata Zwolińska-Wcisło 2

Affiliations

1 Jagiellonian University, Medical College, Cracow, Poland

2 Jagiellonian University, Medical College, Cracow, Poland|||Jagiellonian University, Medical College, Cracow, Poland

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Abstract

Introduction

The brain-gut axis plays a crucial role in the regulation of gastrointestinal (GI) function, with the activity of the autonomic nervous system (ANS) being significantly important. Increased stress, correlated with socioeconomic, behavioral, dietary, and environmental factors, may lead to an overactive sympathetic nervous system response. The aim of this study was to evaluate the correlation between stress and autonomic nervous system responses in gastrointestinal patients.

Aims & Methods

The study comprised 136 GI patients, divided into three groups: the Dyspepsia Group (DG) with 39 patients, a mean age of 37.8 ±11.2 years; the IBS Group (IBS) with 41 patients, a mean age of 45±15 years; and the Celiac Group (CG) with 53 patients, a mean age of 38.2±14 years. ANS activity was assessed using parameters from Heart Rate Variability (HRV) analysis, including time domain, frequency domain, and nonlinear analysis. The severity of stress was assessed using stress indices calculated based on hemodynamic parameters and indicators from linear and nonlinear HRV analysis with the HRV Kubios Premium software.

Results

Patients in the IBS Group exhibited the highest stress indicators and sympathetic ANS activity parameters compared to those in the DG and CG groups (SNS index [stress] p=0.038, SNS index AVG p=0.038). Furthermore, the IBS Group had higher stress indices compared to the DG Group (Stress Index 14.0 vs 9.0; p=0.024). Positive correlations were found between the Stress Index, SNS index (stress), and average heart rate (R=0.525; p=0.0001), as well as with sympathetic ANS activity indices. Negative correlations were observed with indicators of parasympathetic nervous system activity across all investigated groups (R=0.433; p=0.001). A high level of stress, indicated by a Stress Index value above 12, was found in 18% of patients with CD, 38% with IBS, and 28% with DG.

Conclusion

Approximately 27% of GI patients experienced significant levels of stress. The stress indicators positively correlated with sympathetic ANS activation and/either impaired function of the parasympathetic system. Assessing the severity of stress will enable targeted therapy to improve the dysfunctions of the brain-gut axis.

Conference

UEG Week Berlin 2025

Topics

Oesophagus

Submission format

Abstract

Session

OESOPHAGEAL, GASTRIC AND DUODENAL (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Franco Radaelli

UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Who is at risk: Is it all about anticoagulants?

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Who is at risk: Is it all about anticoagulants?

Franco Radaelli 1

Affiliations

1 Valduce Hospital, Como, Italy

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Abstract

Event

UEG Week Berlin 2025

Topics

Endoscopy Radiology & Imaging

Session

Crash course: Lower GI bleeding

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Building a bile duct: What can structural tissue patterning tell us about liver disease?

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Jesper Lagergren

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