Pan-European Registry on H. Pylori Management (HP-EUREG): First-Line Treatments

Abstract

Introduction: Due to the diversity of regimens used as first-line treatment in the Hp-EuReg study, a separate abstract has been created to describe the efficacy of these treatments. Aims and Methods: To evaluate the efficacy of first-line treatments prescribed in the Hp-EuReg.The methodology applied was that established on Hp- EuReg project. Results: Up to now, 4518 na€ıve patients have been included. The most commonly used treatments in order of prescription were: PPI+clarithromycin+amoxicillin (32%); PPI+amoxicillin+nitroimidazole (26%); PPI+clarithromycin+ nitroimidazole (17%); non-bismuth quadruple [concomitant (12%) and sequential (11%)]; bismuth quadruple (2%); others (1%). Table 1 summarizes the results. Overall, in 6.3% of treatments eradication was not confirmed. 32% of first-line treatment failures were not retreated. Compliance ITT (95% CI) mITT (95% CI) PPI+C+A 7 days 97% 73% (69–77%) 76% (72–80%) 10 days 98% 76% (72–80%) 83% (80–87%) >Esomeprazole 82% (73–91%) 87% (79–95%) 14 days 99% 84% (79–89%) 89% (85–94%) >Esomeprazole 89% (82–96%) 90% (83–97%) PPI+A+N 7 days 98% 76% (71–80%) 81% (77–85%) 10 days 97% 75% (71–79%) 82% (79–86%) >Esomeprazole 83% (73–94%) 89% (80–98%) 14 days 99% 82% (75–89%) 85% (79–92%) >Esomeprazole 85% (74–96%) 85% (74–96%) PPI+C+N 7 days 98% 75% (70–80%) 83% (79–87%) 10 days 99% 79% (73–85%) 84% (79–89%) >Esomeprazole 84% (72–96%) 86% (75–97%) 14 days 99% 79% (71–88%) 89% (83–95%) >Esomeprazole 89% (79–99%) 92% (83–100%) Bismuth quadruple 10 days 100% 91% (83–98%) 92% (85–100%) Concomitant 10 days 93% 84% (78–90%) 87% (81–92%) 14 days 99% >Esomeprazole 90% (87–94%) 92% (88–95%) Sequential 10 days 96.8% 87% (84–90%) 89% (86–92%) >Esomeprazole 90% (86–94%) 92% (88–96%) ITT, intention-to-treat; C.I., confidence interval; PPI, proton pump inhibitor; C, clarithromycin; A, amoxicillin; N, nitroimidazols; mITT, modified ITT excluding those patients in which confirmation of eradication was not performed. Conclusion: Most H. pylori eradication treatments prescribed by gastroenterologists in Europe are suboptimal, especially due to the frequent use of the standard triple therapy. Over 90% eradication rate was only achieved with: (i) bismuth-containing quadruple treatment; (ii) extending regimens to 14 days and/or using combinations including esomeprazole.