Pan-European Registry on H. pylori Management (Hp-EuReg): Interim analysis of 4417 second-line treatments

Abstract

Introduction: After a failed eradication attempt, H. pylori treatment’s efficacy is compromised due to the selection or acquisition of resistant strains. Aims: To evaluate the efficacy of second-line treatments in Europe. Methods: 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 (250 so far). An e-CRF was created on AEG-REDCap to systematically register all adult patients infected with H. pylori. Variables included: Patient’s demographics, previous eradication attempts, prescribed eradication treatment, adverse events, and outcomes (cure rates, compliance, follow up, etc.). Data extraction: All cases with treatment failure after just one eradication attempt. Results: Up to now, 4417 second-line treatments have been recorded. Second-line patients had a mean age of 52 years. 3.5% had penicillin allergy. 57% of indications were dyspepsia and 16% gastroduodenal ulcer. Second-line use and efficacy per antibiotic combination is shown in the table. Conclusion: Second-line triple therapies generally provide low eradication rates except when prescribing moxifloxacin for 14 days. Bismuth-containing quadruple therapies seem to provide higher efficacy, especially the combination of bismuth with a PPI, levofloxacin and amoxicillin.