PROBIOTICS PRESCRIBED WITH HELICOBACTER PYLORI ERADICATION THERAPY IN EUROPE: USAGE PATTERN, EFFECTIVENESS, AND SAFETY: Results from the European Registry on Helicobacter pylori Management (Hp-EuReg)

Deza DC 1 , Alcedo J 1 , Lafuente M 2 , López FJ 2 , Perez-Aisa Á 3 , Pavoni M 4 Show all authors , Tepes B 5 , Jonaitis L 6 , Castro-Fernandez M 7 , Pabón-Carrasco M 7 , Keco-Huerga A 7 , Voynovan I 8 , Bujanda L 9 , Lucendo AJ 10 , Jurecic NB 11 , Denkovski M 11 , Vologzanina L 12 , Rodrigo L 13 , Martínez-Domínguez SJ 14 , Fadieienko G 15 , Huguet JM 16 , Abdulkhakov R 17 , Abdulkhakov SR 17 , Alcaide N 18 , Velayos B 18 , Hernández L 19 , Bordin DS 20 , Gasbarrini A 21 , Kupcinskas J 6 , Babayeva G 22 , Gridnyev O 15 , Leja M 23 , Rokkas T 24 , Marcos-Pinto R 25 , Lerang F 26 , Boltin D 27 , Mestrovic A 28 , Smith SM 29 , Venerito M 30 , Boyanova L 31 , Milivojevic V 32 , Doulberis M 33 , Kunovsky L 34 , Parra P 35 , Cano-Català A 36 , Moreira L 37 , Nyssen OP 35 , Megraud F 38 , Morain CO 29 , Gisbert JP 35 , Hp-EuReg investigators

Affiliations 

  • 1 Department of Gastroenterology. Hospital Universitario Miguel Servet, Zaragoza. Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
  • 2 Department of Statistical Methods, Faculty of Science, Universidad de Zaragoza. Instituto de Biocomputación y Física de Sistemas Complejos (BIFI), Universidad de Zaragoza, Spain
  • 3 Digestive Unit, Agencia Sanitaria Costa del Sol, Marbella. Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Marbella, Spain
  • 4 Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
  • 5 Department of Gastroenterology, DC Rogaska, Slatina, Slovenia
  • 6 Research and Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
  • 7 Department of Gastroenterology, Hospital Universitario de Valme, Seville, Spain
  • 8 Department of Gastroenterology, A.S. Loginov Moscow Clinical Scientific Center, Moscow, Russia
  • 9 Department of Gastroenterology, Biodonostia Health Research Institute, San Sebastián. CIBERehd, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid. Department of Medicine, Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
  • 10 Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso. CIBERehd, Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid. Gastroenterology, Instituto de Investigación Sanitaria Princesa, 28006 Madrid, Spain
  • 11 Department of Gastroenterology, Interni Oddelek, Diagnostic Centre, Bled, Slovenia
  • 12 Gastrocenter, Perm, Russia
  • 13 Gastroenterology, University of Oviedo, Oviedo, Spain
  • 14 Servicio de Aparato Digestivo, Hospital Clínico Universitario "Lozano Blesa", Zaragoza. Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza. CIBERehd, Zaragoza, Spain
  • 15 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 of Ukraine, Kharkiv, Ukraine
  • 16 Department of Gastroenterology, Hospital General Universitario de Valencia, Valencia, Spain
  • 17 Department of Hospital Medicine, Kazan State Medical University, Kazan, Russia
  • 18 Department of Gastroenterology, Hospital Clínico de Valladolid, Valladolid, Spain
  • 19 Gastroenterology Unit, Hospital Santos Reyes, Aranda de Duero, Spain
  • 20 Department of Pancreatic, Biliary and upper digestive tract disorders, A. S. Loginov Moscow clinical scientific center, Moscow. Department of propaedeutic of internal diseases and gastroenterology, Russian University of Medicine, Moscow. Department of outpatient therapy and family medicine, Tver State Medical University, Tver, Russia
  • 21 Medicina interna e Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
  • 22 Department of Internal Medicine and Gastroenterology, Azerbaijan State Advanced Training Institute for Doctors named by A.Aliyev, Baku, Azerbaijan
  • 23 Department of Gastroenterology, Digestive Diseases Centre, Riga. Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
  • 24 Gastroenterology Clinic, Henry Dunant Hospital, Athens, Greece
  • 25 Gastroenterology Department, Centro Hospitalar do Porto, Porto. Universidade do Porto, Instituto De Ciências Biomédicas de Abel Salazar, Porto. Center for Research in Health Technologies and Information Systems (CINTESIS), Porto, Portugal
  • 26 Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway
  • 27 Division of Gastroenterology, Rabin Medical Center, TelAviv. Tel Aviv University, TelAviv, Israel
  • 28 Department of Gastroenterology, University Hospital of Split, Split, Croatia
  • 29 School of Medicine, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
  • 30 Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital of Magdeburg, Magdeburg, Germany
  • 31 Department of Medical Microbiology, Medical University of Sofia, Sofia, Bulgaria
  • 32 Clinic of Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade. Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • 33 Gastroenterology Department, Kantonsspital Aarau, Aarau, Switzerland
  • 34 2nd Department of Internal Medicine - Gastroenterology and Geriatrics, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc. Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno. Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Brno, Czech Republic
  • 35 Servicio de Aparato Digestivo. Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
  • 36 Gastrointestinal Oncology, Endoscopy and Surgery (GOES) research group, Althaia Xarxa Assistencial Universitària de Manresa FP, Manresa. Institut de Recerca i Innovació en Ciències de la Vida i de la Salut de la Catalunya Central (IRIS-CC), Vic, Spain
  • 37 Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, Barcelona, Spain
  • 38 INSERM U1312 BRIC, Université de Bordeaux, Bordeaux, France
Am J Gastroenterol, 2025 Feb 04.
PMID: 39902822 DOI: 10.14309/ajg.0000000000003351

Abstract

AIM: To evaluate the prescriptions patterns, effectiveness, and safety of adding probiotics to Helicobacter pylori eradication therapy, in Europe.

DESIGN: International, prospective, non-interventional registry of the clinical practice of the European gastroenterologists. Data were collected and quality reviewed until March 2021 at AEG-REDCap. The effectiveness was evaluated by modified intention-to-treat analysis, differentiating by geographic areas. Adverse events (AE) were categorized as mild, moderate, and severe.

RESULTS: Overall, 36,699 treatments were recorded, where 8,233 (22%) were prescribed with probiotics. Probiotics use was associated with higher effectiveness in the overall analysis (OR 1.631 [95% CI 1.456-1.828]), as well as in triple (1.702 [1.403-2.065]), quadruple (1.383 [0.996-1.920]), bismuth quadruple (1.248 [1.003-1.554] and sequential therapies (3.690 [2.686-5.069]). Lactobacillus genus was associated with a higher therapy effectiveness in Eastern Europe when triple (OR: 2.625 [CI 1.911, 3.606]) and bismuth quadruple (OR: 1.587 [CI 1.117, 2.254]) first-line therapies were prescribed. In Central Europe, the use of probiotics was associated with a decrease in both the overall incidence of AEs (0.656 [0.516, 0.888]) as well as severe AEs (0.312; [0.217, 0.449]). Bifidobacterium genus was associated with lower overall (OR: 0.725 [95% CI 0.592-0.888]) and severe (OR: 0.254 [0.185-0.347]) AEs; and Saccharomyces was associated with reduced overall (OR: 0.54 [CI 0.32-0.91]) and severe (OR 0.257 [CI 0.123-0.536]) AEs under quadruple-bismuth regimen.

CONCLUSIONS: In Europe, the use of probiotics was associated with higher effectiveness and safety of H. pylori eradication therapy. Lactobacillus improved treatment effectiveness, while Bifidobacterium and Saccharomyces were associated with a better safety profile.

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

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