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TIME TRENDS AND EFFECTIVENESS OF BISMUTH TREATMENT FOR HELICOBACTER PYLORI INFECTION: RESULTS FROM THE EUROPEAN REGISTRY ON HELICOBACTER PYLORI MANAGEMENT (HP-EUREG) DURING 2013-2021

Llum Olmedo Borjas 1,2, Xavier Calvet Calvo 3,4, Emili Gené Tous 5,6, Dmitry S. Bordin 7, Irina Voynovan 7, Manuel Castro-Fernández 8, Manuel Pabon-Carrasco 9, Alma Keco-Huerga 9, Ángeles Pérez-Aísa 10, Alfredo J. Lucendo 11, Luis Ricardo Rodrigo Sáez 12, Aiman Sarsenbaeva 13, Igor B. Khlinov 14, Galyna Fadieienko 15, Oleg Zaytsev 16, Angel Lanas 17, Samuel J Martínez-Domínguez 17, Enrique Alfaro Almajano 17, Laimas Virginijus Jonaitis 18, Oscar Núñez Martínez 19, Rinaldo Pellicano 20, Luis Hernández Villalba 21, Oleksiy Gridnyev 15, Juozas Kupcinskas 18, Antonio Gasbarrini 22, Doron Boltin 23, Yaron Niv 24, Gülüstan Babayeva 25, Ricardo Pinto 26, Bojan Tepes 27, Marino Venerito 28, Veronika Papp 29, Frode Lerang 30, Marcis Leja 31, Perminder S Phull 32, Wojciech Marlicz 33, Llum Olmedo Borjas 34, Sinead Smith 35, Vladimir Milivojevic 36, Lumir Kunovsky 37,38,39, ANTE TONKIC 40, Tamara Matysiak-Budnik 41, Halis Simsek 42, Anna Cano-Catala 43, Leticia Moreira Ruiz 44, Pablo Parra 45, Olga P. Nyssen 45, Francis Mégraud 46, Colm O'Morain 35, Javier P. Gisbert 45

Affiliations

1 Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain

2 ABS Manresa 3, Althaia, Xarxa Assistencial Universitària de Manresa, GOES Research Group, Althaia, Manresa, Spain

3 Centro de Investigación Biomédica en Red en Enfermedades Digestivas y Hepáticas (CIBERehd), Unitat de Malalties Digestives, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain

4 Universitat Autònoma de Ba

5 Centro de Investigación Biomédica en Red en Enfermedades Digestivas y Hepáticas (CIBERehd), Servei d'Urgències, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain

6 Universitat Internacional de Catalunya

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

8 Ap.Digestivo, Hospital Universitario de Valme, Sevilla, Spain

9 Hospital Universitario de Valme, Sevilla, Spain

10 Hospital Costa del Sol, Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Marbella, Spain

11 Centro de Investigación Biomédica en Red en Enfermedades Digestivas y Hepáticas (CIBERehd), Department of Gastroenterology, Instituto de Investigación Sanitaria Princesa (IIS-IP), Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, S

12 University of Oviedo, Oviedo, Spain

13 Chelyabinsk Regional Clinical Hospital, Chelyabinsk l, Russian Federation

14 Ural State Medical University, Ekaterinburg, Russian Federation

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

16 First Clinical Medical Center, Kovrov, Russian Federation

17 Hospital Clínico Universitario Lozano Blesa. Instituto de Investigación Sanitaria de Aragón (IIS Aragón). CIBERehd, Zaragoza, Spain

18 Lithuanian University of Health Sciences, Kaunas, Lithuania

19 Hospital Universitario Sanitas La Moraleja, Madrid, Spain

20 Molinette-SGAS Hospital, Turin, Italy

21 Hospital Santos Reyes, Arande de Duero, Spain

22 Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy

23 Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

24 Rabin Medical Center, PetahTikva, Israel

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

26 Centro Hospitalar do Porto, Universidade do Porto, Instituto De Ciências Biomédicas de Abel Salazar, Universidade do Porto, Cintesis, Center for Research in Health Technologies and Information Systems, Porto, Portugal

27 AM DC Rogaska, Rogaska Slatina, Slovenia

28 Otto-von-Guericke University Hospital, Magdeburg, Germany

29 Semmelweis University, Budapest, Hungary

30 Østfold Hospital Trust, Grålum, Norway

31 Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia

32 Aberdeen Royal Infirmary, Aberdeen, United Kingdom

33 Pomeranian Medical University in Szczecin, The Centre for Digestive Diseases, Endoklinica, Szczecin, Poland

34 Kantonsspital Aarau, Aarau, Switzerland

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

36 Clinical Center of Serbia, University of Belgrade School of Medicine, Belgrade, Serbia

37 University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Brno, Czechia

38 University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czechia

39 Masaryk Memorial Cancer Institute, Brno, Czechia

40 University Hospital of Split, University of Split School of Medicine, Split, Croatia

41 University Hospital of Nantes, Nantes, France

42 Department of Gastroenterology, Hacettepe University, Department of Gastroenterology, HC International Clinic, Ankara, Turkey

43 GOES research group, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain

44 Hospital Clínic Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Centro de Investigación Biomédica en Red en Enfermedades Digestivas y Hepáticas (CIBERehd), Barcelona, Spain

45 Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red en Enfermedades Digestivas y Hepáticas (CIBERehd), Madrid, Spain

46 INSERM U1312, Université de Bordeaux, Bordeaux, France

Summary

AI Generated

Analysis of 15,582 patients from the European Registry on Helicobacter pylori management shows bismuth quadruple therapy use increased from 8.6% to 39% over nine years, with 10-day single-capsule BQT and 14-day regimens achieving over 90% effectiveness in Europe.

Single-capsule BQT containing bismuth, metronidazole, and tetracycline plus a PPI was the most commonly used therapy, accounting for 43% of prescriptions.
In treatment-naïve patients, several regimens achieved over 90% effectiveness: 14-day tetracycline plus metronidazole, 10-day single-capsule BQT, and 14-day amoxicillin-based combinations with either clarithromycin or metronidazole.
Single-capsule BQT was the only schedule achieving optimal cure rates across all European geographical regions studied.
Multivariate analysis identified standard- or high-dose PPIs, treatment duration of 10-14 days, single-capsule BQT formulation, and first-line use as significant predictors of higher eradication rates.
The study analyzed 46 different BQT schedules used across 31 European countries, with effectiveness assessed by modified intention-to-treat analysis.

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Abstract

Introduction

Bismuth quadruple therapy (BQT) including bismuth, a proton pump inhibitor (PPI) and two antibiotics has been shown to be a very effective treatment for Helicobacter pylori infection even in areas of high bacterial antibiotic resistance. Bismuth prescriptions seem to be increasing in recent years.

Aims & Methods

To describe the use, effectiveness, and safety of BQT in Europe and the evolution of prescriptions as part of the European Registry on Helicobacter pylori management (Hp-EuReg).

All patients who had received BQT in a 9-year period were included. The thirty-one countries participating in the Hp-EuReg been clustered in previous studies in five main regions based both on their geographical situation and the gross domestic product per capita (North, Centre, Est, South-Est, South-West). Data on the prescribed schedules, previous eradication attempts, effectiveness and the incidence of adverse events was analysed. A time trend analysis of the different BQT treatment prescriptions was likewise performed. Effectiveness was defined by a modified intention-to-treat (mITT) analysis. A multivariate analysis was performed to determine the variables predicting treatment effectiveness.

Results

Of the 49,690 patients included in the Hp-EuReg, 15,582 (31%) had received BQT. BQT use increased from 8.6% to 39% during the study period. Forty-six different schedules were used, of which 8 were administered to more than 100 patients. Single-capsule BQT (ScBQT) containing bismuth, metronidazole and tetracycline plus a PPI was the most used therapy (43%). In naïve patients, the following BQTs obtained over 90% effectiveness: those using tetracycline and metronidazole, either drugs prescribed separately for 14 days, or as 10-day ScBQT; and those using amoxicillin either with clarithromycin or metronidazole, both for 14 days. ScBQT was the only schedule achieving optimal cure rates in all the geographical areas. Standard- or high-dose PPIs, prescriptions of 10-14 days and the schedule type are significantly related to higher cure rates in the multivariate analysis.

Table.Predictive factors of treatment effectiveness in multivariate analysis

Variable	OR	95% CI		p
Variable	OR	lower	upper	p
PPI dose (ref. low dose)	1.25	1.17	1.33	<0.0001
Duration of treatment	1.36	1.25	1.48	<0,0001
Rescue therapy	0.62	0.54	0.68	<0.0001
Gender	1.19	1.07	1.32	0.001
Europe region	0.89	0.85	0.94	<0.0001
ScBQT	2.18	1.90	2.50	<0.0001
PPI-CAB	1.31	1.11	1.56	0.002
PPI-MTB	1.50	1.05	2.14	0.024

PPI, proton pump inhibitor; PPI dose: low 4.5–27 mg, standard 32–40 mg, high 54–128 mg; ScBQT, single-capsule containing bismuth, tetracycline, and metronidazole; A, amoxicillin; B, bismuth salts; C, clarithromycin; M, metronidazole; T, tetracycline.

Conclusion

The use of BQT has increased progressively in the last decade.10-Day ScBQT or 14-day BQT schedules achieved an effectiveness over 90% in Europe.

Disclosure

Prof. J. Gisbert has served as speaker, consultant, and advisory member for or has received research funding from Mayoly, Allergan, Diasorin, Gebro Pharma, and Richen.

Conference

UEG Week Copenhagen 2023

Topics

Stomach & H. Pylori

Submission format

Abstract

Session

H. pylori at interfaces (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Approaches to improve nutrition and physical activity levels in patients with liver disease

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