Online Articles: Original Articles

Room for Improvement in the Treatment of Helicobacter pylori Infection

Lessons from the European Registry on H. pylori Management (Hp-EuReg)

Nyssen, Olga P. BSc, PhD^*; Vaira, Dino MD^†; Tepes, Bojan MD^‡; Kupcinskas, Limas MD^§; Bordin, Dmitry MD^∥; Pérez-Aisa, Ángeles MD^¶; Gasbarrini, Antonio MD^#; Castro-Fernández, Manuel MD^**; Bujanda, Luis MD^††; Garre, Ana MD^*; Lucendo, Alfredo MD^‡‡; Vologzhanina, Liudmila MD^§§; Jurecic, Natasa B. MD^∥∥; Rodrigo-Sáez, Luis MD^¶¶; Huguet, Jose M. MD^##; Voynovan, Irina MD^∥; Perez-Lasala, Jorge MD^***; Romero, Pilar Mata MD^†††; Vujasinovic, Miroslav MD^‡‡‡; Abdulkhakov, Rustam MD^§§§; Barrio, Jesús MD^∥∥∥; Fernandez-Salazar, Luis MD^¶¶¶; Mégraud, Francis MD^###; O’Morain, Colm MD^****; Gisbert, Javier P. MD, PhD^*

Author Information

^*Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)

^***Digestive Service, HM Sanchinarro, Madrid

^¶Digestive Unit, Agencia Sanitaria Costa del Sol, Marbella, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Málaga

^**Digestive Unit, Hospital de Valme, Sevilla

^††Department of Gastroenterology, Hospital Donostia/Instituto Biodonostia. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd). Universidad del País Vasco (UPV/EHU), Donostia

^‡‡Hospital de Tomelloso, Ciudad Real, Tomelloso

^¶¶Gastroenterology Unit, Hospital Universitario Central de Asturias, Oviedo

^##Hospital General Universitario de Valencia, Valencia

^†††Hospital San Pedro de Alcántara, Cáceres

^∥∥∥Hospital Río Hortega

^¶¶¶Hospital Clínico Universitario, Valladolid, Spain

^†Department of Surgical and Clinical Sciences, University of Bologna, Bologna

^#Gastronterology Area, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy

^‡Gastroenterology Unit, AM DC Rogaska, Rogaska Slatina

^∥∥DC Bled

^‡‡‡Slovenj Gradec General Hospital, Slovenj Gradec, Slovenia

^§Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania

^∥Department of Pancreatobiliary and Upper GI Diseases, Moscow Clinical Scientific Center, and A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow

^§§Gastrocentre Perm, Perm

^§§§Kazan State Medical University, Kazan, Russia

^###Laboratoire de Bactériologie, Hôpital Pellegrin, Bordeaux Cedex, France

^****Trinity College Dublin, Faculty of Health Sciences, Trinity College Dublin, Dublin/IE, Faculty of Health Sciences, Dublin, Ireland

Dr Gisbert has served as a speaker, a consultant and advisory member for or has received research funding from Casen Recordati, Mayoly, Allergan, Advia, Diasorin. Dr P. Nyssen has received research funding from Allergan. Dr Jonaitis has served as a speaker for KRKA, Ferring, Abbvie, Janssen. For the remaining authors declare that they have nothing to disclose.

Address correspondence to: Javier P. Gisbert, MD, PhD, Gastroenterology Unit, Hospital Universitario de La Princesa, Diego de León, 62. 28006 Madrid, Spain (e-mail: [email protected]).

Journal of Clinical Gastroenterology 56(2):p e98-e108, February 2022. | DOI: 10.1097/MCG.0000000000001482

Abstract

Background:

Managing Helicobacter pylori infection requires constant decision making, and each decision is open to possible errors.

Aim:

The aim was to evaluate common mistakes in the eradication of H. pylori, based on the “European Registry on Helicobacter pylori management”.

Methods:

European Registry on Helicobacter pylori management is an international multicentre prospective noninterventional registry evaluating the decisions and outcomes of H. pylori management by European gastroenterologists in routine clinical practice.

Results:

Countries recruiting more than 1000 patients were included (26,340 patients). The most common mistakes (percentages) were: (1) To use the standard triple therapy where it is ineffective (46%). (2) To prescribe eradication therapy for only 7 to 10 days (69%). (3) To use a low dose of proton pump inhibitors (48%). (4) In patients allergic to penicillin, to prescribe always a triple therapy with clarithromycin and metronidazole (38%). (5) To repeat certain antibiotics after eradication failure (>15%). (6) Failing to consider the importance of compliance with treatment (2%). (7) Not to check the eradication success (6%). Time-trend analyses showed progressive greater compliance with current clinical guidelines.

Conclusion:

The management of H. pylori infection by some European gastroenterologists is heterogeneous, frequently suboptimal and discrepant with current recommendations. Clinical practice is constantly adapting to updated recommendations, although this shift is delayed and slow.

Article Keywords

Keywords
Helicobacter pylori, H. pylori, amoxicillin, clarithromycin, metronidazole, levofloxacin, bismuth, non-bismuth, mistake, error

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Room for Improvement in the Treatment of Helicobacter pylori Infection

Lessons from the European Registry on H. pylori Management (Hp-EuReg)