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Evolution of the use, effectiveness and safety of bismuth-containing quadruple therapy for Helicobacter pylori infection between 2013 and 2021: results from the European registry on H. pylori management (Hp-EuReg)

Olmedo L 1 , Calvet X 2 , Gené E 1 , Bordin DS 3 , Voynovan I 4 , Castro-Fernandez M 5 Show all authors , Pabón-Carrasco M 6 , Keco-Huerga A 6 , Perez-Aisa Á 7 , Lucendo AJ 5 , Rodrigo L 8 , Sarsenbaeva AS 9 , Khlinov IB 10 , Fadieienko G 11 , Zaytsev O 12 , Lanas Á 5 , Martínez-Domínguez SJ 5 , Alfaro E 13 , Jonaitis L 14 , Núñez Ó 15 , Pellicano R 16 , Hernández L 17 , Gridnyev O 11 , Kupcinskas J 18 , Gasbarrini A 19 , Boltin D 20 , Niv Y 21 , Babayeva G 22 , Marcos-Pinto R 23 , Tepes B 24 , Venerito M 25 , Papp V 26 , Lerang F 27 , Leja M 28 , Phull PS 29 , Marlicz W 30 , Doulberis M 31 , Smith SM 32 , Milivojevic V 33 , Kunovsky L 34 , Mestrovic A 35 , Matysiak-Budnik T 36 , Simsek H 37 , Cano-Català A 38 , Puig I 38 , Moreira L 5 , Parra P 5 , Nyssen OP 5 , Megraud F 39 , O'Morain C 40 , Gisbert JP 5 , Hp-EuReg investigators*

Affiliations 

  • 1 Medicina, Programa de Doctorado en Ciencias de la Salud, Universitat Internacional de Catalunya, Sant Cugat del Valles, Barcelona, Spain
  • 2 Servei d'Aparell Digestiu, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA). Universitat Autònoma de Barcelona, Sabadell, Spain xcalvet@tauli.cat
  • 3 Department of Pancreatic, Biliary and Upper Digestive Tract Disorders, AS Loginov Moscow Clinical Scientific Center, Moscow, Russian Federation
  • 4 Department of Gastroenterology, AS Loginov Moscow Clinical Scientific Center, Moscow, Russian Federation
  • 5 Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
  • 6 Department of Gastroenterology, Hospital Universitario de Valme, Sevilla, Spain
  • 7 Department of Gastroenterology, Hospital Universitario Costa del Sol, Marbella, Spain
  • 8 Department of Gastroenterology, University of Oviedo, Oviedo, Spain
  • 9 Department of Gastroenterology, Chelyabinsk Regional Clinical Hospital, Chelyabinsk, Russian Federation
  • 10 Department of faculty therapy and geriatrics, Ural State Medical University, Ekaterinburg, Russian Federation
  • 11 Departments the Division for the Study of the Digestive diseases and its Comorbidity with Noncommunicable Diseases, Government Institution L.T. Malaya Therapy National Institute of NAMS, Kharkiv, Ukraine
  • 12 First Clinical Medical Centre, Kovrov, Russian Federation
  • 13 Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
  • 14 Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
  • 15 Department of Gastroenterology, Hospital Universitario La Moraleja, Madrid, Spain
  • 16 Department of Gastroenterology, Molinette-SGAS Hospital, Turin, Italy
  • 17 Department of Gastroenterology, Hospital Santos Reyes, Aranda de Duero, Spain
  • 18 Institute for Digestive Research and Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
  • 19 Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
  • 20 Department of Gastroenterology, Rabin Medical Center, Tel Aviv, Israel
  • 21 Dr. Miriam and Sheldon G. Adelson School of Medicine, Ariel University, Ari'el, Israel
  • 22 Department of Therapy, Azerbaijan State Advanced Training Institute for Doctors named by A. Aliyev, Baku, Azerbaijan
  • 23 Department of Gastroenterology, Centro Hospitalar do Porto, Porto, Portugal
  • 24 Department of Gastroenterology, DC Rogaska, Rogaska Slatina, Slovenia
  • 25 Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital of Magdeburg, Magdeburg, Germany
  • 26 Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
  • 27 Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway
  • 28 Department of Gastroenterology, Digestive Diseases Centre, Riga, Latvia
  • 29 Department of Digestive Disorders, Aberdeen Royal Infirmary, Aberdeen, UK
  • 30 Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
  • 31 Department of Gastroenterology, Kantonsspital Aarau, Aarau, Switzerland
  • 32 School of Medicine, Trinity College Dublin, Dublin, Ireland
  • 33 Department of Gastroenterology and Hepatology, University Clinical Centre of Serbia, Belgrade University, Belgrade, Serbia
  • 34 2nd Department of Internal Medicine - Gastroenterology and Geriatrics, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
  • 35 Department of Gastroenterology, University Hospital of Split, Split, Croatia
  • 36 Department of Hepato-Gastroenterology & Digestive Oncology, University Hospital of Nantes, Nantes, France
  • 37 Department of Gastroenterology, Hacettepe University, Ankara, Turkey
  • 38 Gastrointestinal Oncology Endoscopy and Surgery (GOES) research group, Althaia Xarxa Assistencial Universitària de Manresa. Institut de Recerca i Innovació en Ciències de la Vida i de la Salut de la Catalunya Central (IRIS-CC), Manresa, Barcelona, Spain
  • 39 Université de Bordeaux, INSERM U1312 BRIC, Bordeaux, France
  • 40 Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
Gut, 2024 Dec 10;74(1):15-25.
PMID: 39461739 DOI: 10.1136/gutjnl-2024-332804

Abstract

BACKGROUND: Bismuth quadruple therapies (BQTs) including bismuth, a proton pump inhibitor (PPI) and two antibiotics have been shown to be highly effective for treating Helicobacter pylori infection even in areas of high bacterial antibiotic resistance.

OBJECTIVE: To describe the time trends of use, effectiveness and safety of BQT in Europe using the European Registry on Helicobacter pylori Management (Hp-EuReg).

DESIGN: Patients registered in the Hp-EuReg from 2013 to 2021 who had received BQT were included. The regimens prescribed, the number of eradication attempts, effectiveness, adherence and safety were analysed. The effectiveness was assessed by modified intention to treat (mITT). Time-trend and multivariate analyses were performed to determine variables that predicted treatment success.

RESULTS: Of the 49 690 patients included in the Hp-EuReg, 15 582 (31%) had received BQT. BQT use increased from 8.6% of all treatments in 2013 to 39% in 2021. Single-capsule BQT-containing bismuth, metronidazole and tetracycline-plus a PPI (single-capsule BQT, ScBQT) was the most frequent treatment mode (43%). Schemes that obtained an effectiveness above 90% were the 10-day ScBQT and 14-day BQT using tetracycline plus metronidazole, or amoxicillin plus either clarithromycin or metronidazole. Only ScBQT achieved above 90% cure rates in all the geographical areas studied. Using the ScBQT scheme, adherence, the use of standard or high-dose PPIs, 14-day prescriptions and the use of BQT as first-line treatment were significantly associated with higher mITT effectiveness.

CONCLUSION: The use of BQT increased notably in Europe over the study period. A 10-day ScBQT was the scheme that most consistently achieved optimal effectiveness.

TRIAL REGISTRATION NUMBER: NCT02328131.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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