Pan-European registry on H. Pylori management (HP-EUREG): first-line treatments and interim analysis of 20,000 patients

Abstract

Introduction: Due to the diversity of strains, resistances and geographical particularities, the best approach for Helicobacter pylori management remains unclear. Aims & Methods: We aimed to assess the management of H. pylori infection by gastroenterologists in Europe and to evaluate the efficacy of first-line treatments. A systematic prospective registry of the clinical practice of European gastroenterologists regarding H. pylori infection and treatment (30 countries and 250 recruiting investigators). A local coordinator was selected from each country with more than 10 H. pylori references on PubMed. Each coordinator selected a representative group of recruiting investigators from its country. An electronic clinical research file was created on AEG-REDCap to systematically register all adult patients infected with H. pylori. Variables included: Patients’ demographics, previous eradication attempts, prescribed eradication treatment, adverse events, and outcomes (cure rates, compliance, follow up, etc.). Results: Up to now, 20,175 patients (60% women) have finished follow up. Mean age was 49 years. Of all patients, 4.2% had drug allergies (81% to penicillin), 56% of had dyspepsia, 18% had gastroduodenal ulcer. Two-thirds (66%) were diagnosed using endoscopy-based methods. The treatments were: first-line in 78% of the patients, second-line in 16%, third-line in 4.4%, fourth-line in 1.2%, and fifth-line in 0.4%. Within the first-line prescriptions, 56% of firstline prescriptions were triple regimens (PPIþ2 antibiotics), 21% non-bismuth quadruple concomitant, 9% sequential, and 7% bismuth quadruple. Overall, first-line modified intention-to-treat (mITT) eradication rate was 78%. Firstline efficacy per antibiotic combination is shown in the table. Conclusion: H. pylori management by gastroenterologists in Europe is extremely diverse and the overall eradication rate is suboptimal, mainly due to the frequent use of trip