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THE INFLUENCE OF INDICATIONS FOR HELICOBACTER PYLORI INVESTIGATION ON PRESCRIPTIONS AND EFFECTIVENESS: EUROPEAN REGISTRY ON H. PYLORI MANAGEMENT (HP-EUREG)

Samuel Jesús Martínez-Domínguez 1, Olga P. Nyssen 2, Angel Lanas 3, Enrique Alfaro 4, Laimas Virginijus Jonaitis 5, Umud Mahmudov 6, Irina Voynovan 7, Gülüstan Babayeva 8, Luis Ricardo Rodrigo Sáez 9, Giulia Fiorini 10, Ángeles Pérez-Aísa 11, Javier Tejedor-Tejada 12, Bojan Tepes 13, Liudmila Vologzhanina 14, Emin Mammadov 15, Frode Lerang 16, Farid Guliyev 17, Natalia Bakulina 18, Rustam A Abdulkhakov 19, Tatiana Ilchishina 20, Thomas Butler 21, Aiman Sarsenbaeva 22, Renate Bumane 23, Alfredo J. Lucendo 24, Marco Romano 25, Luis Bujanda Fernández de Piérola 26, Sayar Abdulkhakov 27, Oleg Zaytsev 28, Manuel Pabon-Carrasco 29, Alma Keco-Huerga 29, Maja Denkovski 30, Jose Maria Huguet 31, Monica Cecilia Perona Vincenti 32, Oscar Núñez Martínez 33, Matteo Pavoni 34, Galyna Fadieienko 35, Sergei Alekseenko 36, Sinead Smith 37, Luis Hernández Villalba 38, Juozas Kupcinskas 39, Dmitry S. Bordin 7, Marcis Leja 40, Antonio Gasbarrini 41, Oleksiy Gridnyev 42, Anna Cano Català 43, Pablo Parra 44, Leticia Moreira Ruiz 45, Francis Mégraud 46, Colm O'Morain 47, Javier P. Gisbert 48

Affiliations

1 Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain|||Aragón Health Research Institute, Zaragoza, Spain|||Facultad de medicina, Universidad de Zaragoza, Zaragoza, Spain

2 Hospital Universitario de La Princesa, IIS-IP, and CIBERehd, Madrid, Spain

3 University of Zaragoza University Hospital Dept. of Medicine-Gastroenterology, Zaragoza, Spain

4 Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain

5 Lithuanian University of Health Sciences Dept. of Gastroenterology, Kaunas, Lithuania

6 Modern Hospital, Baku, Azerbaijan

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

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

9 University of Oviedo, Oviedo, Spain

10 Sant´Orsola Hospital Dept. of Internal Medicine, Bologna, Italy

11 Agencia Sanitaria Costa del Sol, Marbella, Spain

12 Hospital Universitario de Cabueñes, Gijón, Spain

13 DC ROGASKA d.o.o., Rogaska Slatina, Slovenia

14 Gastrocenter, Perm, Russian Federation

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

16 Central Hosspital of Ostfold, Grålum, Norway

17 National Oncology Centre, Baku, Azerbaijan

18 North-Western State Medical University n. a. I. I. Mechnikov, St. Petersburg, Russian Federation

19 Kazan State Medical University, Kazan, Russian Federation

20 SM-clinic, Saint-Petersburg, Russian Federation

21 Trinity College Dublin, Dublin, Ireland

22 Chelyabinsk Regional Clinical Hospital, Chelyabinsk, Russian Federation

23 Digestive Diseases Centre GASTRO, Riga, Latvia

24 Hospital General de Tomelloso, Tomelloso, Spain

25 Universitá Vanvitelli, Napoli, Italy

26 Instituto Biodonostia, San Sebastián, Spain

27 I.I. Mechnikov North-Western State Medical University of the Ministry of Health of the Russian Federation, Saint Petersburg, Russian Federation

28 First Clinical Medical CentrE, Kovrov, Russian Federation

29 Hospital Universitario de Valme, Sevilla, Spain

30 Diagnostic centre, Bled, Slovenia

31 Hospital General Universitario de Valencia, Valencia, Spain

32 Hospital Quiron Marbella, Marbella, Spain

33 Hospital Sanitas La Moraleja, San Sebastian De Los Reyes, Spain

34 University of Bologna, Bologna, Italy

35 Government Institution L.T. Malaya Therapy National Institute of NAMS of Ukraine, Kharkiv, Ukraine

36 Far Eastern State Medical University, Khabarovsk, Russian Federation

37 Trinity College Dublin/Tallaght University Hospital, Dublin, Ireland

38 Santos Reyes, Aranda de Duero, Spain

39 Lithuanian University of Health Sciences, Kaunas, Lithuania

40 University of Latvia, Riga, Latvia

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

42 /National institute of therapy named L.T.Malaya NAMS of Ukraine, Kharkiv, Ukraine

43 Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain

44 Hospital de la Princesa, Madrid, Spain

45 Hospital Clinic de Barcelona, Gava, Spain

46 Hopital Pellegrin, Laboratoire de Bacteriologie, Bordeaux, France

47 Trinity College Dublin, Faculty of Health Sciences, Dublin, Ireland

48 Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa and CIBEREHD, Madrid, Spain

Summary

AI Generated

Analysis of 53,636 treatment-naïve H. pylori patients from 34 European countries found that indications were inappropriate in 5.6% of cases, with treatment effectiveness varying by indication from 87% to 91% and bismuth quadruple therapies achieving optimal results in nearly all indications.

Treatment effectiveness varied significantly by indication: duodenal ulcer (91%), gastric ulcer (90%), preneoplastic lesions (90%), dyspepsia with normal endoscopy (89%), GERD (88%), and non-investigated dyspepsia (87%).
Bismuth quadruple therapies (both BMTc and CAB formulations) reached 90% effectiveness in almost all indications except GERD, with cure rates consistently described as optimal.
Concomitant clarithromycin-amoxicillin-tinidazole/metronidazole therapy achieved 90% effectiveness except in non-investigated dyspepsia, while triple therapies showed suboptimal eradication rates in all indications with the exception of Lithuania.
Therapeutic compliance was higher in patients with duodenal ulcer and preneoplastic lesions (98% and 99%), while adverse events were more frequent in patients treated for dyspepsia with normal endoscopy compared to duodenal ulcer.
This registry study is relevant for gastroenterologists managing H. pylori infection and making decisions about treatment regimens based on clinical indication.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

The role of indications for Helicobacter pylori investigation on prescriptions and effectiveness is uncertain.

Aims & Methods

To assess the appropriateness of indications for H. pylori treatment, and its influence on prescriptions and effectiveness. International, prospective, non-interventional registry of the management of H. pylori infection by European gastroenterologists (Hp-EuReg). Treatment-näive patients registered from 2013 to July 2023 at e-CRF AEG-REDCap were included. Effectiveness was evaluated by modified intention-to-treat analysis.

Results

Overall, 53,636 treatment-naïve patients from 34 countries were analyzed. Indications were inappropriate in 2,989 (5.6%) cases. Most common indications were: dyspepsia with normal endoscopy (49%), non-investigated dyspepsia (20%), duodenal ulcer (11%), gastric ulcer (7.7%), and gastroesophageal reflux disease (GERD) (2.6%). Treatment effectiveness varied by indication: duodenal ulcer (91%), gastric ulcer (90%), preneoplastic lesions (90%), dyspepsia with normal endoscopy (89%), GERD (88%), and non-investigated dyspepsia (87%); p<0.001. Bismuth quadruple therapies reached 90% effectiveness in all indications except GERD. The effectiveness with PPI-bismuth-metronidazole-tetracycline (quadruple-BMTc) was lower in patients treated for non-investigated dyspepsia as compared to those with dyspepsia with normal endoscopy, however, in all cases cure rates were optimal (91.8% vs. 93.9%, p= 0.047). In Spain, these latter results were also confirmed in the same indications (92% vs. 94%, p=<0.05), and similar scenario was observed for quadruple-BMTc in patients with dyspepsia from Russia and Italy, but did not reach statistical significance. PPI-clarithromycin-amoxicillin-bismuth showed similar effectiveness rates for dyspepsia with normal endoscopy and non-investigated dyspepsia (93%), also confirmed in Spain, Russia and Azerbaijan. Concomitant clarithromycin-amoxicillin-tinidazole/metronidazole (CAT-CAM) achieved 90% except in patients with non-investigated dyspepsia. Most of concomitant-CAT-CAM therapies (36%) were prescribed in Spain, where the effectiveness was suboptimal in patients with non-investigated dyspepsia (87%), dyspepsia with normal endoscopy (89.8%) and GERD (89%) (p<0.001). Triple therapies showed suboptimal eradications rates in all indications with the exception of Lithuania, where optimal effectiveness was observed in patients with non-investigated dyspepsia (99%, p=0.009). Adverse events were higher in patients treated for dyspepsia with normal endoscopy as compared to duodenal ulcer (23% vs. 28%, p<0.001). Therapeutic compliance was higher in patients with duodenal ulcer and preneoplastic lesions (98% and 99%, p<0.001).

Table 1. Overall effectiveness (by modified intention-to-treat) of first-line treatment schemes.

Indications, n (%)	Spain	Russia	Azerbaijan	Italy	Slovenia	Lithuania	Others	Total
Triple-CA Non-investigated Dyspepsia Dyspepsia with normal endoscopy Duodenal Ulcer Gastric Ulcer Preneoplastic lesions GERD Total p-value	577 (75.3)† 1,208 (86.2)* 341 (89.5)* 217 (88.2) 94 (83.9) 35 (89.7) 2,472 (83.9) <0.001	348 (84.9) 847 (82.8) 302 (81.8) 268 (82.0) 52 (92.9) 69 (75.8) 1,886 (82.9) 0.119	37 (92.5) 1,532 (90.9) 134 (93.7) 232 (91.0) 2 (100.0) 27 (96.4) 1,964 (91.2) 0.713	31 (68.9)† 76 (87.4) 21 (91.3) 12 (92.3) 0 (0.0) 5 (83.3) 145 (82.9) 0.015	378 (89.6) 900 (90.7) 199 (94.8) 128 (87.1) 18 (94.7) 282 (92.5) 1,905 (90.9) 0.127	68 (98.6)* 799 (85.4) 65 (78.3)† 38 (88.4) 1 (50.0) 7 (87.5) 978 (85.7) 0.009	920 (82.1)† 1,027 (86.4) 279 (90.6)* 183 (88.0) 125 (88.0) 44 (83.0) 2,578 (85.4) 0.001	2,359 (82.1)† 6,389 (87.4)* 1,341 (88.4)* 1,078 (87.0) 292 (87.4) 469 (88.5) 11,928 (86.4) <0.001
Concomitant-CAT-CAM Non-investigated Dyspepsia Dyspepsia with normal endoscopy Duodenal Ulcer Gastric Ulcer Preneoplastic lesions GERD Total p-value	1,974 (86.8)† 2,097 (89.8) 767 (94.1)* 331 (91.9) 123 (94.6) 73 (89.0) 5,365 (89.5) <0.001	1 (100.0) 30 (88.2) 19 (90.5) 10 (83.3) 0 (0.0) 1 (100.0) 61 (88.4) -	0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) -	57 (95.0) 219 (95.2) 6 (85.7) 14 (87.5) 4 (80.0) 34 (97.1) 334 (94.6) 1.000	3 (75.0) 9 (90.0) 1 (100.0) 1 (100.0) 0 (0.0) 0 (0.0) 14 (87.5) -	0 (0.0) 0 (0.0) 0 (0.0) 1 (100.0) 0 (0.0) 0 (0.0) 1 (100.0) -	220 (92.1) 456 (94.8) 72 (90.0) 32 (91.4) 6 (100.0) 20 (95.2) 806 (93.5) 0.265	2,255 (87.5)† 2,811 (90.9) 865 (93.6)* 389 (91.5) 133 (94.3) 128 (92.1) 6,581 (90.2) <0.001
Quadruple-BMTc Non-investigated Dyspepsia Dyspepsia with normal endoscopy Duodenal Ulcer Gastric Ulcer Preneoplastic lesions GERD Total p-value	1,762 (91.5)† 2,144 (94.1)* 525 (94.8) 302 (92.9) 83 (92.2) 70 (90.9) 4,886 (93.1) 0.017	38 (92.7) 125 (94.0) 21 (91.3) 16 (100.0) 2 (66.7) 0 (0.0) 202 (93.5) 0.722	0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) -	153 (93.9) 403 (95.7) 23 (85.2)† 30 (96.8) 23 (100.0) 19 (90.5) 651 (94.9) 0.049	0 (0.0) 2 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (100.0) -	0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) -	149 (92.0) 350 (90.7) 44 (83.0) 56 (87.5) 10 (100.0) 8 (80.0) 617 (90.1) 0.259	2,102 (91.8)† 3,024 (93.9)* 613 (93.3) 404 (92.7) 118 (93.7) 97 (89.8) 6,358 (93.0) 0.047
Quadruple-CAB Non-investigated Dyspepsia Dyspepsia with normal endoscopy Duodenal Ulcer Gastric Ulcer Preneoplastic lesions GERD Total p-value	274 (91.6) 455 (91.5) 99 (96.1) 45 (97.8) 26 (86.7) 13 (86.7) 912 (92.1) 0.195	219 (94.4) 2,069 (93.3) 389 (91.3) 348 (94.3) 132 (91.0) 58 (89.2) 3,215 (93.1) 0.296	2 (100.0) 157 (98.7) 243 (99.2)* 227 (96.2)† 0 (0.0) 0 (0.0) 629 (98.0) 0.034	0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) -	0 (0.0) 0 (0.0) 0 (0.0) 1 (100.0) 0 (0.0) 1 (100.0) 2 (100.0) -	4 (100.0) 31 (83.8) 3 (100.0) 3 (100.0) 1 (100.0) 0 (0.0) 42 (87.5) -	25 (100.0) 92 (81.4) 31 (72.1)† 10 (100.0) 49 (96.1)* 0 (0.0) 207 (85.5) 0.001	524 (93.2) 2,804 (92.7) 765 (93.3) 634 (95.3) 208 (91.6) 72 (88.9) 5,007 (93.1) 0.113

A: Amoxicillin, B: Bismuth salts, C: Clarithromycin, GERD: gastroesophageal reflux disease, M: Metronidazole, Tc: Tetracycline. Group “Success” (*) or "Failure" (†) statistically significant.

Conclusion

In Europe, indications for H. pylori investigation could be improved in 5.6% of patients. Higher effectiveness was observed in patients treated for gastric or duodenal ulcers and preneoplastic lesions. Bismuth and non-bismuth quadruple therapies reached optimal results in almost all indications.

Disclosure

Dr. Samuel J. Martínez-Domínguez has served as a speaker for Juvisé. Dr. Ángel Lanas has served as a speaker for Juvisé. Dr. Gisbert has served as a speaker, a consultant and advisory member for or has received research funding from Mayoly, Allergan, Diasorin, Biocodex, Juvisé and Richen. Dr. Nyssen has received research funding from Mayoly, Allergan, Diasorin, Biocodex, Juvisé and Richen.

Conference

UEG Week Vienna 2024

Topics

Stomach & H. Pylori

Submission format

Abstract

Session

H.pylori treatment: Part 1 (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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