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)

Diego Burgos-Santamaría, Olga P Nyssen, Antonio Gasbarrini, Dino Vaira, Ángeles Pérez-Aisa, Luís Rodrigo, Rinaldo Pellicano, Alma Keco-Huerga, Manuel Pabón-Carrasco, Manuel Castro-Fernandez, Doron Boltin, Jesus Barrio, Perminder Phull, Juozas Kupcinskas, Laimas Jonaitis, Inmaculada Ortiz-Polo, Bojan Tepes, Alfredo J Lucendo, José María Huguet, Miguel AreiaNatasa Brglez Jurecic, Maja Denkovski, Luís Bujanda, June Ramos-San Román, Antonio Cuadrado-Lavín, Judith Gomez-Camarero, Manuel Alfonso Jiménez Moreno, Angel Lanas, Samuel Jesús Martinez-Dominguez, Enrique Alfaro, Ricardo Marcos-Pinto, Vladimir Milivojevic, Theodore Rokkas, Marcis Leja, Sinead Smith, Ante Tonkić, György Miklós Buzás, Michael Doulberis, Marino Venerito, Frode Lerang, Dmitry S Bordin, Vincent Lamy, Lisette G Capelle, Wojciech Marlicz, Daniela Dobru, Oleksiy Gridnyev, Ignasi Puig, Francis Mégraud, Colm O'Morain, Javier P Gisbert

Research output: Contribution to journalArticle

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.
Original languageEnglish
Pages (from-to)1054-1072
Number of pages19
JournalEGUT
Volume72
DOIs
Publication statusPublished - 2022

Keywords

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

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