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  3. Empirical rescue treatment of Helicobacter pylori infection in third and subsequent lines: 8-year experience in 2144 patients from the European Registry on H. pylori management (Hp-EuReg)

Empirical rescue treatment of Helicobacter pylori infection in third and subsequent lines: 8-year experience in 2144 patients from the European Registry on H. pylori management (Hp-EuReg)

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Autores de IDIVAL

Autores ajenos al IDIVAL

  • Burgos-Santamaria, D
  • Nyssen, OP
  • Gasbarrini, A
  • Vaira, D
  • Perez-Aisa, A
  • Rodrigo, L
  • Pellicano, R
  • Keco-Huerga, A
  • Pabon-Carrasco, M
  • Castro-Fernandez, M
  • Boltin, D
  • Barrio, J
  • Phull, P
  • Kupcinskas, J
  • Jonaitis, L
  • Ortiz-Polo, I
  • Tepes, B
  • Lucendo, AJ
  • Huguet, JM
  • Areia, M
  • Jurecic, NB
  • Denkovski, M
  • Bujanda, L
  • Ramos-San Roman, J
  • Gomez-Camarero, J
  • Moreno, MAJ
  • Lanas, A
  • Martinez-Dominguez, SJ
  • Alfaro, E
  • Marcos-Pinto, R
  • Milivojevic, V
  • Rokkas, T
  • Leja, M
  • Smith, S
  • Tonkic, A
  • Buzas, GM
  • Doulberis, M
  • Venerito, M
  • Lerang, F
  • Bordin, DS
  • Lamy, V
  • Capelle, LG
  • Marlicz, W
  • Dobru, D
  • Gridnyev, O
  • Puig, I
  • Megraud, F
  • O'Morain, C
  • Gisbert, JP
  • Hp-EuReg Investigators

Unidades

Abstract

Objective To evaluate the use, effectiveness and safety of Helicobacter pylori empirical rescue therapy in third and subsequent treatment lines in Europe. Design International, prospective, non-interventional registry of the clinical practice of European gastroenterologists. Data were collected and quality reviewed until October 2021 at Asociacion Espanola de Gastroenterologia-Research Electronic Data Capture. All cases with three or more empirical eradication attempts were assessed for effectiveness by modified intention-to-treat and per-protocol analysis. Results Overall, 2144 treatments were included: 1519, 439, 145 and 41 cases from third, fourth, fifth and sixth treatment lines, respectively. Sixty different therapies were used; the 15 most frequently prescribed encompassed > 90% of cases. Overall effectiveness remained < 90% in all therapies. Optimised treatments achieved a higher eradication rate than non-optimised (78% vs 67%, p < 0.0001). From 2017 to 2021, only 44% of treatments other than 10-day single-capsule therapy used high proton-pump inhibitor doses and lasted & GE;14 days. Quadruple therapy containing metronidazole, tetracycline and bismuth achieved optimal eradication rates only when prescribed as third-line treatment, either as 10-day single-capsule therapy (87%) or as 14-day traditional therapy with tetracycline hydrochloride (95%). Triple amoxicillin-levofloxacin therapy achieved 90% effectiveness in Eastern Europe only or when optimised. The overall incidence of adverse events was 31%. Conclusion Empirical rescue treatment in third and subsequent lines achieved suboptimal effectiveness in most European regions. Only quadruple bismuth-metronidazole-tetracycline (10-day single-capsule or 14-day traditional scheme) and triple amoxicillin-levofloxacin therapies reached acceptable outcomes in some settings. Compliance with empirical therapy optimisation principles is still poor 5 years after clinical practice guidelines update.

© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

Datos de la publicación

ISSN/ISSNe:
0017-5749, 1468-3288

GUT  B M J PUBLISHING GROUP

Tipo:
Article
Páginas:
1054-1072
PubMed:
36591610

Citas Recibidas en Web of Science: 6

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Keywords

  • Helicobacter pylori; antibiotic therapy; antibiotics; drug resistance; proton pump inhibition

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