Introduction
Although national guidance on the management of Helicobacter pylori (H. pylori) infection in the UK is reviewed regularly, the recommendations on treatment and follow-up are not aligned with guidance in the rest of Europe. This is mainly due to the issue that there are no up to date data available on H. pylori prevalence or primary resistance to drugs usually used in eradication regimens.
Aims & Methods
Aim of this study was to analyse the current UK practice on H. pylori management to highlight areas that warrant improvement. UK data collected at AEG-REDCap e-CRF until January 2025 from the European Registry on H. pylori management (Hp-EuReg) were analysed. Modified intention-to-treat (mITT) and per protocol (PP) analyses were performed and the Fisher’s exact test was used for comparison of categorical data (significance for p<0.05).
Results
Data on 462 patients from 3 different centres across the UK was analysed. The mean age of the patients was 55 years (SD 16 years). The indication to test for H. pylori was non-investigated dyspepsia in 47%, dyspepsia with normal endoscopy in 21%, iron deficiency anaemia in 10%, duodenal ulcer in 9.7%, gastric ulcer in 6.9%, and gastric preneoplastic conditions in 1.3%. Of the 257 patients for whom data on regular concurrent medication was available, 222 (87%) took proton pump inhibitors (PPI) daily. Standard triple therapy regimens were given in 97.6% with 90.9% of these having undergone a 7-day regimen, 1.7% a 10-day regimen and 7.4% a 14-day regimen. Most commonly prescribed regimens were amoxicillin-clarithromycin-PPI (75.5%), amoxicillin-metronidazole-PPI (11.1%) and clarithromycin-metronidazole-PPI (9.1%). In the majority of cases, PPI was prescribed at low dose (76%); standard dose was given in 21%, and high dose in 3% of patients. The incidence of at least one adverse event due to treatment was reported in 31% of cases. Tests to confirm eradication success were done in 85% of patients, with practice varying between the different sites (p<0.001). This was also confirmed for the length of prescribed treatment (p<0.001) and the PPI dose used (p<0.001). Eradication was successful in 71% in the mITT analysis, and in 71% of the PP analysis. Patients treated for 7 days showed treatment success in 70% in the mITT analysis, and 69.4% in the PP analysis, compared to 93% (both mITT and PP) in those treated for 14 days (p<0.01). Adverse events were associated with reduced eradication treatment success (mITT: 62 vs 76%; PP: 63 vs 76%; p<0.01). The effect was more pronounced for compliance, with only 5 patients having reported not to have completed >90% of their course of treatment (PP: 29% vs 80%, p<0.05). Second-line treatment was documented for 109 patients, with 20 different regimens having been prescribed. The overall mITT success of second-line treatment was 48.5%.
Conclusion
Clarithromycin-based triple therapy remains the standard in the UK, despite a treatment failure of ≈30%. While adherence to national British or European guidelines on treatment duration and PPI dosage varies by centre, this does not uniformly affect treatment success. Despite British guidance advocating to assess treatment success based on symptom response, eradication was confirmed in the majority of patients. A review of national guidance on H. pylori management in the UK is required, along with efforts to generate national data on prevalence and resistance patterns.
Disclosure
JB: Advisory fee by Flynn Pharma LTD UK and Juvise Pharmaceuticals France
OPN: Speaker fee or research funding from Allergan, Mayoly Spindler, Richen, Biocodex and Juvisé.
JPG: Speaker or consultancy fees, advisory board member or research funding form Mayoly, Allergan/Abbvie, Diasorin, Richen, Juvisé, Biocodex.
IB, MCS, ACC, PP, LM, FM, COM, and PP have no conflict of interest to declare.