Pan-European Registry on H. Pylori management (Hp-EuReg): first-line treatments and interim analysis of 11 272 patients

Abstract

Introduction: Due to the diversity of strains, resistances and geographical par- ticularities, the most efficient management strategy of H. pylori infection is still to be found. Aims: To evaluate the management of H. pylori infection by gastroenterologists in Europe and to evaluate the efficacy of first-line treatments. Methods: A systematic prospective registry of the clinical practice of European gastroenterologists regarding H. pylori infection and treatment (30 countries and 250 centers). From each country a local coordinator was appointed who selected a representative group of recruiting investigators. Data was registered on an electronic-clinical-research-file (e-CRF). Results: Eleven thousand two-hundred and seventy-two patients have been included, and 9181 finished follow-up (59%females, 87%caucasian). Mean age 55 years. 4.2% had drug-allergies (81% penicillin). 20% had gastroduodenal ulcer. 66% diagnosed using endoscopy. 77% were first-line treatments, 16% second-line, 4.5%third-line, 1.3%fourth-line, and 0.4%fifth-line. 61% of pre- scriptions were triple regimens (PPI + 2 antibiotics), 16% non-bismuth quadru- ple concomitant, 11% sequential, and 7% bismuth-quadruple. 30% of patients had adverse events (11.5% diarrhea, 11.3% metallic taste,11.3% nausea) although they were mostly mild (53%) and lasted an average of 6.4 days, caus- ing treatment discontinuation in 0.3% of cases. Overall eradication rate was 80%, and only 67% of eradication failures were retreated. First-line ITT: triple therapy (PPI+ clarithromycin+amoxicillin; 10 days) 78% eradication rate (81% in 14 day treatments), sequential (10 days) 87%, concomitant 88% (90% in 14 day), and bismuth-quadruple 92%. Conclusion: H. pylori management by gastroenterologists in Europe is extre- mely diverse. It is important to notice that the overall eradication rate seems suboptimal. Continuation of this registry and deeper evaluation of its data may o