1
|
Bujanda L, Nyssen OP, Ramos J, Bordin DS, Tepes B, Perez-Aisa A, Pavoni M, Castro-Fernandez M, Lerang F, Leja M, Rodrigo L, Rokkas T, Kupcinskas J, Jonaitis L, Shvets O, Gasbarrini A, Simsek H, Phull PS, Buzás GM, Machado JC, Boltin D, Boyanova L, Tonkić A, Marlicz W, Venerito M, Vologzanina L, Fadieienko GD, Fiorini G, Resina E, Muñoz R, Cano-Català A, Puig I, García-Morales N, Hernández L, Moreira L, Megraud F, Morain CO, Montes M, Gisbert JP. Effectiveness of Helicobacter pylori Treatments According to Antibiotic Resistance. Am J Gastroenterol 2024; 119:646-654. [PMID: 37983769 DOI: 10.14309/ajg.0000000000002600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/02/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Antibiotic resistance is one of the main factors that determine the efficacy of treatments to eradicate Helicobacter pylori infection. Our aim was to evaluate the effectiveness of first-line and rescue treatments against H. pylori in Europe according to antibiotics resistance. METHODS Prospective, multicenter, international registry on the management of H. pylori (European Registry on H. pylori Management). All infected and culture-diagnosed adult patients registered in the Spanish Association of Gastroenterology-Research Electronic Data Capture from 2013 to 2021 were included. RESULTS A total of 2,852 naive patients with culture results were analyzed. Resistance to clarithromycin, metronidazole, and quinolones was 22%, 27%, and 18%, respectively. The most effective treatment, regardless of resistance, were the 3-in-1 single capsule with bismuth, metronidazole, and tetracycline (91%) and the quadruple with bismuth, offering optimal cure rates even in the presence of bacterial resistance to clarithromycin or metronidazole. The concomitant regimen with tinidazole achieved an eradication rate of 99% (90/91) vs 84% (90/107) with metronidazole. Triple schedules, sequential, or concomitant regimen with metronidazole did not achieve optimal results. A total of 1,118 non-naive patients were analyzed. Resistance to clarithromycin, metronidazole, and quinolones was 49%, 41%, and 24%, respectively. The 3-in-1 single capsule (87%) and the triple therapy with levofloxacin (85%) were the only ones that provided encouraging results. DISCUSSION In regions where the antibiotic resistance rate of H. pylori is high, eradication treatment with the 3-in-1 single capsule, the quadruple with bismuth, and concomitant with tinidazole are the best options in naive patients. In non-naive patients, the 3-in-1 single capsule and the triple therapy with levofloxacin provided encouraging results.
Collapse
Affiliation(s)
- Luis Bujanda
- 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
| | - Olga P Nyssen
- Gastroenterology Department, 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
| | - June Ramos
- 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
| | - Dmitry S Bordin
- 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, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow; Department of Outpatient Therapy and Family Medicine, Tver State Medical University, Tver, Russia
| | - Bojan Tepes
- Department of Gastroenterology, DC Rogaska, Slatina, Slovenia
| | | | - Matteo Pavoni
- Department of Medical and Surgical Sciences, IRCCS St. Orsola Polyclinic, University of Bologna, Bologna, Italy
| | | | - Frode Lerang
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway
| | - Mārcis Leja
- Gastro, Digestive Diseases Centre, Riga; Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
| | - Luis Rodrigo
- Gastroenterology, University of Oviedo, Oviedo, Spain
| | - Theodore Rokkas
- Gastroenterology Clinic, Henry Dunant Hospital, Athens, Greece
| | - Juozas Kupcinskas
- Institute for Digestive Research and Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Laimas Jonaitis
- Institute for Digestive Research and Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Oleg Shvets
- Department of Gastroenterology, Internal Medicine, National Medical University, Kyiv, Ukraine
| | - Antonio Gasbarrini
- Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Halis Simsek
- Department of Gastroenterology, Hacettepe University, Ankara; Department of Gastroenterology, HC International Clinic, Ankara, Turkey
| | - Perminder S Phull
- Department of Digestive Disorders, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Jose C Machado
- 3S-Instituto de Investigação e Inovação Em Saúde da Universidade Do Porto, Porto; Ipatimup-Instituto de Patologia e Imunologia Molecular da Universidade Do Porto, Porto; Pathology, FMUP-Faculdade de Medicina Do Porto, Porto, Portugal
| | - Doron Boltin
- Division of Gastroenterology, Rabin Medical Center, PetahTikva; Sackler School of Medicine, Tel Aviv University, TelAviv, Israel
| | - Lyudmila Boyanova
- Department of Medical Microbiology, Medical University of Sofia, Sofia, Bulgaria
| | - Ante Tonkić
- Department of Gastroenterology, University Hospital of Split, Split, Croatia
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University in Szczecin, Szczecin; The Centre for Digestive Diseases, Endoklinika, Szczecin, Poland
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital of Magdeburg, Magdeburg, Germany
| | | | - Galina D Fadieienko
- L.T. Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
| | - Giulia Fiorini
- Department of Medical and Surgical Sciences, IRCCS St. Orsola Polyclinic, University of Bologna, Bologna, Italy
| | - Elena Resina
- Gastroenterology Department, 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
| | - Raquel Muñoz
- Gastroenterology Department, 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
| | - Anna Cano-Català
- GOES Research Group, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Ignasi Puig
- Althaia Xarxa Assistencial Universitària de Manresa and Universitat de Vic-Universitat Central de Catalunya (UVicUCC), Manresa, Spain
| | - Natalia García-Morales
- Complexo Hospitalario Universitario de Vigo (CHUVI) and Galicia Sur Health Research Institute (IIS Galicia Sur); SERGAS-UVIGO, Spain
| | - Luis Hernández
- Unidad de Gastroenterología, Hospital Santos Reyes, Aranda de Duero, Spain
| | - Leticia Moreira
- 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
| | | | | | - Milagrosa Montes
- Department of Microbiology, Donostia University Hospital-Biodonostia Health Research Institute, San Sebastian, Spain
| | - Javier P Gisbert
- Gastroenterology Department, 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
| |
Collapse
|
2
|
Jonaitis P, Nyssen OP, Saracino IM, Fiorini G, Vaira D, Pérez-Aísa Á, Tepes B, Castro-Fernandez M, Pabón-Carrasco M, Keco-Huerga A, Voynovan I, Lucendo AJ, Lanas Á, Martínez-Domínguez SJ, Almajano EA, Rodrigo L, Vologzanina L, Brglez Jurecic N, Denkovski M, Bujanda L, Mahmudov U, Leja M, Lerang F, Babayeva G, Bordin DS, Gasbarrini A, Kupcinskas J, Gridnyev O, Rokkas T, Marcos-Pinto R, Phull PS, Smith SM, Tonkić A, Boltin D, Buzás GM, Šembera Š, Şimşek H, Matysiak-Budnik T, Milivojevic V, Marlicz W, Venerito M, Boyanova L, Doulberis M, Capelle LG, Cano-Català A, Moreira L, Mégraud F, O'Morain C, Gisbert JP, Jonaitis L. Author Correction: Comparison of the management of Helicobacter pylori infection between the older and younger European populations. Sci Rep 2023; 13:18821. [PMID: 37914853 PMCID: PMC10620194 DOI: 10.1038/s41598-023-45888-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Affiliation(s)
- Paulius Jonaitis
- Department of Gastroenterology, Lithuanian University of Health Sciences, 50161, Kaunas, Lithuania
| | - Olga P Nyssen
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad Autónoma de Madrid (UAM), Diego de León, 62, 28006, Madrid, Spain.
| | - Ilaria Maria Saracino
- Department of Surgical and Medical Sciences, IRCCS AOUBO, University of Bologna, 40138, Bologna, Italy
| | - Giulia Fiorini
- Department of Surgical and Medical Sciences, IRCCS AOUBO, University of Bologna, 40138, Bologna, Italy
| | - Dino Vaira
- Department of Surgical and Medical Sciences, IRCCS AOUBO, University of Bologna, 40138, Bologna, Italy
| | - Ángeles Pérez-Aísa
- Agencia Sanitaria Costa del Sol, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 29651, Marbella, Spain
| | - Bojan Tepes
- Department of Gastroenterology, AM DC Rogaska, 3250, Rogaska Slatina, Slovenia
| | | | | | - Alma Keco-Huerga
- Department of Gastroenterology, Hospital de Valme, 41014, Seville, Spain
| | - Irina Voynovan
- Department of Gastroenterology, A.S. Loginov Moscow Clinical Scientific Center, 111123, Moscow, Russia
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, 13700, Tomelloso, Spain
| | - Ángel Lanas
- IIS Aragón y Facultad de Medicina de la Universidad de Zaragoza, 50009, Zaragoza, Spain
| | | | | | - Luis Rodrigo
- Gastroenterology Unit, Hospital Universitario Central de Asturias, 33011, Oviedo, Spain
| | | | - Natasa Brglez Jurecic
- Department of Gastroenterology, Interni Oddelek, Diagnostic Centre, 4260, Bled, Slovenia
| | - Maja Denkovski
- Department of Gastroenterology, Interni Oddelek, Diagnostic Centre, 4260, Bled, Slovenia
| | - Luis Bujanda
- Hospital Donostia, Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), 20018, San Sebastián, Spain
| | | | - Mārcis Leja
- Department of Gastroenterology, Digestive Diseases Centre Gastro, Institute of Clinical and Preventive Medicine and Faculty of Medicine, University of Latvia, Riga, 1079, Latvia
| | - Frode Lerang
- Department of Gastroenterology, Østfold Hospital Trust, 1714, Grålum, Norway
| | | | - Dmitry S Bordin
- Department of Gastroenterology, A.S. Loginov Moscow Clinical Scientific Center, 111123, Moscow, Russia
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, 127473, Moscow, Russia
- Tver State Medical University, 170100, Tver, Russia
| | - Antonio Gasbarrini
- Medicina Interna, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Juozas Kupcinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, 50161, Kaunas, Lithuania
| | - Oleksiy Gridnyev
- Government Institution "L.T.Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine", Kyiv, Ukraine
| | - Theodore Rokkas
- Department of Gastroenterology, Henry Dunant Hospital, 115 26, Athens, Greece
| | - Ricardo Marcos-Pinto
- Department of Gastroenterology, Centro Hospitalar do Porto Institute of Biomedical Sciences Abel Salazar, Centro de Investigação em Tecnologias e Serviços de Saúde, University of Porto, 4050-313, Porto, Portugal
| | - Perminder S Phull
- Department of Gastroenterology, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, UK
| | - Sinead M Smith
- Faculty of Health Sciences, Trinity College Dublin, Dublin, D02PN40, Ireland
| | - Ante Tonkić
- Department of Gastroenterology, University Hospital of Split, University of Split School of Medicine, 21000, Split, Croatia
| | - Doron Boltin
- Division of Gastroenterology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, 49100, Tel Aviv, Israel
| | - György Miklós Buzás
- Department of Gastroenterology, Ferencváros Health Centre, 1095, Budapest, Hungary
| | - Štěpán Šembera
- 2nd Department of Internal Medicine and Gastroenterology, University Hospital and Charles University, Faculty of Medicine in Hradec Králové, 500 03, Hradec Králové, Czech Republic
| | - Halis Şimşek
- Division of Gastroenterology and Hepatology, Hacettepe University School of Medicine, 06230, Ankara, Turkey
| | - Tamara Matysiak-Budnik
- Department of Gastroenterology, CHRU de Nantes, Hôpital Hôtel Dieu, 44000, Nantes, France
| | - Vladimir Milivojevic
- Department of Gastroenterology, Clinical Center of Serbia, University of Belgrade School of Medicine, 11000, Belgrade, Serbia
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, 70-204, Szczecin, Poland
| | - Marino Venerito
- Department of Gastroenterology, Otto-Von-Guericke University, 39120, Magdeburg, Germany
| | - Lyudmila Boyanova
- Department of Gastroenterology, Medical Microbiology, Medical University of Sofia, 1431, Sofia, Bulgaria
| | - Michael Doulberis
- Division of Gastroenterology and Hepatology, Medical University Department, Kantonsspital Aarau, 5001, Aarau, Switzerland
| | - Lisette G Capelle
- Department of Gastroenterology, Meander Medical Center, 3813 TZ, Amersfoort, The Netherlands
| | - Anna Cano-Català
- GOES Research Group, Althaia Xarxa Assistencial Universitària de Manresa, 08243, Manresa, Spain
| | - Leticia Moreira
- Department of Gastroenterology, Hospital Clínic 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, 08036, Barcelona, Spain
| | - Francis Mégraud
- INSERM U1312, Université de Bordeaux, 33000, Bordeaux, France
| | - Colm O'Morain
- Faculty of Health Sciences, Trinity College Dublin, Dublin, D02PN40, Ireland
| | - Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad Autónoma de Madrid (UAM), Diego de León, 62, 28006, Madrid, Spain
| | - Laimas Jonaitis
- Department of Gastroenterology, Lithuanian University of Health Sciences, 50161, Kaunas, Lithuania
| |
Collapse
|
3
|
Jonaitis P, Nyssen OP, Saracino IM, Fiorini G, Vaira D, Pérez-Aísa Á, Tepes B, Castro-Fernandez M, Pabón-Carrasco M, Keco-Huerga A, Voynovan I, Lucendo AJ, Lanas Á, Martínez-Domínguez SJ, Almajano EA, Rodrigo L, Vologzanina L, Brglez Jurecic N, Denkovski M, Bujanda L, Mahmudov U, Leja M, Lerang F, Babayeva G, Bordin DS, Gasbarrini A, Kupcinskas J, Gridnyev O, Rokkas T, Marcos-Pinto R, Phull PS, Smith SM, Tonkić A, Boltin D, Buzás GM, Šembera Š, Şimşek H, Matysiak-Budnik T, Milivojevic V, Marlicz W, Venerito M, Boyanova L, Doulberis M, Capelle LG, Cano-Català A, Moreira L, Mégraud F, O'Morain C, Gisbert JP, Jonaitis L. Comparison of the management of Helicobacter pylori infection between the older and younger European populations. Sci Rep 2023; 13:17235. [PMID: 37821503 PMCID: PMC10567783 DOI: 10.1038/s41598-023-43287-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023] Open
Abstract
The prevalence of Helicobacter pylori remains high in the older population. Specific age-related peculiarities may impact the outcomes of H. pylori treatment. The aim of the study was to evaluate the diagnostics and effectiveness of H. pylori eradication between the younger and older European populations. "European Registry on H. pylori Management (Hp-EuReg)" data from 2013 to 2022 were analyzed. Patients were divided into older (≥ 60 years) and younger (18-59 years) groups. Modified intention-to-treat (mITT) and per-protocol (PP) analysis was performed. 49,461 patients included of which 14,467 (29%) were older-aged. Concomitant medications and penicillin allergy were more frequent among the older patients. Differences between younger and older populations were observed in treatment duration in first-line treatment and in proton pump inhibitors (PPIs) doses in second-line treatment. The overall incidence of adverse events was lower in the older adults group. The overall first-line treatment mITT effectiveness was 88% in younger and 90% in the older patients (p < 0.05). The overall second-line mITT treatment effectiveness was 84% in both groups. The effectiveness of the most frequent first- and second-line triple therapies was suboptimal (< 90%) in both groups. Optimal efficacy (≥ 90%) was achieved by using bismuth and non-bismuth-based quadruple therapies. In conclusion, the approach to the diagnostics and treatment of H. pylori infection did not generally differ between younger and older patients. Main differences were reported in the concurrent medications, allergy to penicillin and adverse events both in first- and second-line treatment. Optimal effectiveness rates were mostly achieved by using bismuth and non-bismuth-based quadruple therapies. No clinically relevant differences in the effectiveness between the age groups were observed.
Collapse
Affiliation(s)
- Paulius Jonaitis
- Department of Gastroenterology, Lithuanian University of Health Sciences, 50161, Kaunas, Lithuania
| | - Olga P Nyssen
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad Autónoma de Madrid (UAM), Diego de León, 62, 28006, Madrid, Spain.
| | - Ilaria Maria Saracino
- Department of Surgical and Medical Sciences, IRCCS AOUBO, University of Bologna, 40138, Bologna, Italy
| | - Giulia Fiorini
- Department of Surgical and Medical Sciences, IRCCS AOUBO, University of Bologna, 40138, Bologna, Italy
| | - Dino Vaira
- Department of Surgical and Medical Sciences, IRCCS AOUBO, University of Bologna, 40138, Bologna, Italy
| | - Ángeles Pérez-Aísa
- Agencia Sanitaria Costa del Sol, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 29651, Marbella, Spain
| | - Bojan Tepes
- Department of Gastroenterology, AM DC Rogaska, 3250, Rogaska Slatina, Slovenia
| | | | | | - Alma Keco-Huerga
- Department of Gastroenterology, Hospital de Valme, 41014, Seville, Spain
| | - Irina Voynovan
- Department of Gastroenterology, A.S. Loginov Moscow Clinical Scientific Center, 111123, Moscow, Russia
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, 13700, Tomelloso, Spain
| | - Ángel Lanas
- IIS Aragón y Facultad de Medicina de la Universidad de Zaragoza, 50009, Zaragoza, Spain
| | | | | | - Luis Rodrigo
- Gastroenterology Unit, Hospital Universitario Central de Asturias, 33011, Oviedo, Spain
| | | | - Natasa Brglez Jurecic
- Department of Gastroenterology, Interni Oddelek, Diagnostic Centre, 4260, Bled, Slovenia
| | - Maja Denkovski
- Department of Gastroenterology, Interni Oddelek, Diagnostic Centre, 4260, Bled, Slovenia
| | - Luis Bujanda
- Hospital Donostia, Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), 20018, San Sebastián, Spain
| | | | - Mārcis Leja
- Department of Gastroenterology, Digestive Diseases Centre Gastro, Institute of Clinical and Preventive Medicine and Faculty of Medicine, University of Latvia, Riga, 1079, Latvia
| | - Frode Lerang
- Department of Gastroenterology, Østfold Hospital Trust, 1714, Grålum, Norway
| | | | - Dmitry S Bordin
- Department of Gastroenterology, A.S. Loginov Moscow Clinical Scientific Center, 111123, Moscow, Russia
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, 127473, Moscow, Russia
- Tver State Medical University, 170100, Tver, Russia
| | - Antonio Gasbarrini
- Medicina Interna, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Juozas Kupcinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, 50161, Kaunas, Lithuania
| | - Oleksiy Gridnyev
- Government Institution "L.T.Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine", Kyiv, Ukraine
| | - Theodore Rokkas
- Department of Gastroenterology, Henry Dunant Hospital, 115 26, Athens, Greece
| | - Ricardo Marcos-Pinto
- Department of Gastroenterology, Centro Hospitalar do Porto Institute of Biomedical Sciences Abel Salazar, Centro de Investigação em Tecnologias e Serviços de Saúde, University of Porto, 4050-313, Porto, Portugal
| | - Perminder S Phull
- Department of Gastroenterology, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, UK
| | - Sinead M Smith
- Faculty of Health Sciences, Trinity College Dublin, Dublin, D02PN40, Ireland
| | - Ante Tonkić
- Department of Gastroenterology, University Hospital of Split, University of Split School of Medicine, 21000, Split, Croatia
| | - Doron Boltin
- Division of Gastroenterology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, 49100, Tel Aviv, Israel
| | - György Miklós Buzás
- Department of Gastroenterology, Ferencváros Health Centre, 1095, Budapest, Hungary
| | - Štěpán Šembera
- 2nd Department of Internal Medicine and Gastroenterology, University Hospital and Charles University, Faculty of Medicine in Hradec Králové, 500 03, Hradec Králové, Czech Republic
| | - Halis Şimşek
- Division of Gastroenterology and Hepatology, Hacettepe University School of Medicine, 06230, Ankara, Turkey
| | - Tamara Matysiak-Budnik
- Department of Gastroenterology, CHRU de Nantes, Hôpital Hôtel Dieu, 44000, Nantes, France
| | - Vladimir Milivojevic
- Department of Gastroenterology, Clinical Center of Serbia, University of Belgrade School of Medicine, 11000, Belgrade, Serbia
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, 70-204, Szczecin, Poland
| | - Marino Venerito
- Department of Gastroenterology, Otto-Von-Guericke University, 39120, Magdeburg, Germany
| | - Lyudmila Boyanova
- Department of Gastroenterology, Medical Microbiology, Medical University of Sofia, 1431, Sofia, Bulgaria
| | - Michael Doulberis
- Division of Gastroenterology and Hepatology, Medical University Department, Kantonsspital Aarau, 5001, Aarau, Switzerland
| | - Lisette G Capelle
- Department of Gastroenterology, Meander Medical Center, 3813 TZ, Amersfoort, The Netherlands
| | - Anna Cano-Català
- GOES Research Group, Althaia Xarxa Assistencial Universitària de Manresa, 08243, Manresa, Spain
| | - Leticia Moreira
- Department of Gastroenterology, Hospital Clínic 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, 08036, Barcelona, Spain
| | - Francis Mégraud
- INSERM U1312, Université de Bordeaux, 33000, Bordeaux, France
| | - Colm O'Morain
- Faculty of Health Sciences, Trinity College Dublin, Dublin, D02PN40, Ireland
| | - Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad Autónoma de Madrid (UAM), Diego de León, 62, 28006, Madrid, Spain
| | - Laimas Jonaitis
- Department of Gastroenterology, Lithuanian University of Health Sciences, 50161, Kaunas, Lithuania
| |
Collapse
|
4
|
Nyssen OP, Pratesi P, Spínola MA, Jonaitis L, Pérez-Aísa Á, Vaira D, Saracino IM, Pavoni M, Fiorini G, Tepes B, Bordin DS, Voynovan I, Lanas Á, Martínez-Domínguez SJ, Alfaro E, Bujanda L, Pabón-Carrasco M, Hernández L, Gasbarrini A, Kupcinskas J, Lerang F, Smith SM, Gridnyev O, Leja M, Rokkas T, Marcos-Pinto R, Meštrović A, Marlicz W, Milivojevic V, Simsek H, Kunovsky L, Papp V, Phull PS, Venerito M, Boyanova L, Boltin D, Niv Y, Matysiak-Budnik T, Doulberis M, Dobru D, Lamy V, Capelle LG, Nikolovska Trpchevska E, Moreira L, Cano-Català A, Parra P, Mégraud F, O’Morain C, Ortega GJ, Gisbert JP. Analysis of Clinical Phenotypes through Machine Learning of First-Line H. pylori Treatment in Europe during the Period 2013-2022: Data from the European Registry on H. pylori Management (Hp-EuReg). Antibiotics (Basel) 2023; 12:1427. [PMID: 37760723 PMCID: PMC10525558 DOI: 10.3390/antibiotics12091427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
The segmentation of patients into homogeneous groups could help to improve eradication therapy effectiveness. Our aim was to determine the most important treatment strategies used in Europe, to evaluate first-line treatment effectiveness according to year and country. Data collection: All first-line empirical treatments registered at AEGREDCap in the European Registry on Helicobacter pylori management (Hp-EuReg) from June 2013 to November 2022. A Boruta method determined the "most important" variables related to treatment effectiveness. Data clustering was performed through multi-correspondence analysis of the resulting six most important variables for every year in the 2013-2022 period. Based on 35,852 patients, the average overall treatment effectiveness increased from 87% in 2013 to 93% in 2022. The lowest effectiveness (80%) was obtained in 2016 in cluster #3 encompassing Slovenia, Lithuania, Latvia, and Russia, treated with 7-day triple therapy with amoxicillin-clarithromycin (92% of cases). The highest effectiveness (95%) was achieved in 2022, mostly in Spain (81%), with the bismuth-quadruple therapy, including the single-capsule (64%) and the concomitant treatment with clarithromycin-amoxicillin-metronidazole/tinidazole (34%) with 10 (69%) and 14 (32%) days. Cluster analysis allowed for the identification of patients in homogeneous treatment groups assessing the effectiveness of different first-line treatments depending on therapy scheme, adherence, country, and prescription year.
Collapse
Affiliation(s)
- Olga P. Nyssen
- Digestive System Service of the Hospital Universitario de La Princesa, 28006 Madrid, Spain; (O.P.N.); (P.P.); (J.P.G.)
- Instituto de Investigación Sanitaria Princesa (IIS-Princesa), 28006 Madrid, Spain
- Departamento de Medicina, Universidad Autónoma de Madrid (UAM), 28049 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain; (Á.L.); (S.J.M.-D.); (L.B.); (L.M.)
| | - Pietro Pratesi
- Dipartimento di Statistica e Metodi Quantitativi (DISMEQ), Universitá degli studi di Milano–Bicocca, 20126 Milano, Italy;
| | - Miguel A. Spínola
- Unidad de Análisis de Datos del Instituto de Investigación Sanitaria Princesa (IIS-Princesa), 28006 Madrid, Spain;
| | - Laimas Jonaitis
- Institute for Digestive Research, Department of Gastroenterology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (L.J.); (J.K.)
| | | | - Dino Vaira
- Department of Surgical and Medical Sciences, Sant’Orsola-Malpighi University Hospital, 40138 Bologna, Italy; (D.V.); (I.M.S.); (M.P.); (G.F.)
- Cardiovascular Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Ilaria Maria Saracino
- Department of Surgical and Medical Sciences, Sant’Orsola-Malpighi University Hospital, 40138 Bologna, Italy; (D.V.); (I.M.S.); (M.P.); (G.F.)
| | - Matteo Pavoni
- Department of Surgical and Medical Sciences, Sant’Orsola-Malpighi University Hospital, 40138 Bologna, Italy; (D.V.); (I.M.S.); (M.P.); (G.F.)
| | - Giulia Fiorini
- Department of Surgical and Medical Sciences, Sant’Orsola-Malpighi University Hospital, 40138 Bologna, Italy; (D.V.); (I.M.S.); (M.P.); (G.F.)
| | - Bojan Tepes
- Department of Gastroenterology, DC Rogaska, 3250 Rogaska Slatina, Slovenia;
| | - Dmitry S. Bordin
- Department of Pancreatic, Biliary and Upper Digestive Tract Disorders, A. S. Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia; (D.S.B.); (I.V.)
- Department of Outpatient Therapy and Family Medicine, Tver State Medical University, 170100 Tver, Russia
- Department of Propaedeutic of Internal Diseases and Gastroenterology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, 127473 Moscow, Russia
| | - Irina Voynovan
- Department of Pancreatic, Biliary and Upper Digestive Tract Disorders, A. S. Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia; (D.S.B.); (I.V.)
| | - Ángel Lanas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain; (Á.L.); (S.J.M.-D.); (L.B.); (L.M.)
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain;
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain
| | - Samuel J. Martínez-Domínguez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain; (Á.L.); (S.J.M.-D.); (L.B.); (L.M.)
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain;
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain
| | - Enrique Alfaro
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain;
| | - Luis Bujanda
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain; (Á.L.); (S.J.M.-D.); (L.B.); (L.M.)
- Department of Gastroenterology, Biodonostia Health Research Institute, 20014 San Sebastián, Spain
- Department of Medicine, Universidad del País Vasco (UPV/EHU), 20014 San Sebastián, Spain
| | - Manuel Pabón-Carrasco
- Department of Gastroenterology, Hospital Universitario de Valme, 41014 Seville, Spain;
| | - Luis Hernández
- Gastroenterology Unit, Hospital Santos Reyes, 09400 Aranda de Duero, Spain;
| | - Antonio Gasbarrini
- Medicina interna e Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Juozas Kupcinskas
- Institute for Digestive Research, Department of Gastroenterology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (L.J.); (J.K.)
| | - Frode Lerang
- Department of Gastroenterology, Østfold Hospital Trust, 1714 Grålum, Norway;
| | - Sinead M. Smith
- School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland; (S.M.S.); (C.O.)
| | - Oleksiy Gridnyev
- 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, 61039 Kharkiv, Ukraine;
| | - Mārcis Leja
- Department of Gastroenterology, Digestive Diseases Centre, LV-1006 Riga, Latvia;
- Institute of Clinical and Preventive Medicine, LV-1079 Riga, Latvia
- Faculty of Medicine, University of Latvia, LV-1004 Riga, Latvia
| | - Theodore Rokkas
- Gastroenterology Clinic, Henry Dunant Hospital, 115 26 Athens, Greece;
| | - Ricardo Marcos-Pinto
- Gastroenterology Department, Centro Hospitalar do Porto, 4150-001 Porto, Portugal;
- Instituto De Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, 4050-313, Porto, Portugal
- Center for Research in Health Technologies and Information Systems (CINTESIS), 4200-450 Porto, Portugal
| | - Antonio Meštrović
- Department of Gastroenterology, University Hospital of Split, 21000 Split, Croatia;
- School of Medicine, University of Split, 21000 Split, Croatia
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Vladimir Milivojevic
- Department of Gastroenterology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Halis Simsek
- Department of Gastroenterology, HC International Clinic, Hacettepe University, 06690 Ankara, Turkey;
| | - Lumir Kunovsky
- Department of Internal Medicine—Gastroenterology and Geriatrics, University Hospital Olomouc, 779 00 Olomouc, Czech Republic;
- Faculty of Medicine and Dentistry, Palacky University Olomouc, 779 00 Olomouc, Czech Republic
- Department of Surgery, University Hospital Brno, 625 00 Brno, Czech Republic
- Faculty of Medicine, Masaryk University, 601 77 Brno, Czech Republic
- Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic
| | - Veronika Papp
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1085 Budapest, Hungary;
| | - Perminder S. Phull
- Department of Digestive Disorders, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK;
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital of Magdeburg, 39120 Magdeburg, Germany;
| | - Lyudmila Boyanova
- Department of Medical Microbiology, Medical University of Sofia, 1431 Sofia, Bulgaria;
| | - Doron Boltin
- Division of Gastroenterology, Rabin Medical Center, Tel Aviv University, Tel Aviv-Yafo 49100, Israel;
| | - Yaron Niv
- Adelson Faculty of Medicine, Ariel University, Ariel 4070000, Israel;
| | - Tamara Matysiak-Budnik
- Hepato-Gastroenterology & Digestive Oncology Unit, University Hospital of Nantes, 44000 Nantes, France;
| | - Michael Doulberis
- Gastroenterology Department, Kantonsspital Aarau, 5001 Aarau, Switzerland;
| | - Daniela Dobru
- Department of Gastroenterology, University of Medicine, Pharmacy, Science, and Technology of Târgu Mures, 540142 Târgu Mures, Romania;
| | - Vincent Lamy
- Department of Gastroenterology & Hepatology, CHU de Charleroi, 6042 Charleroi, Belgium;
| | - Lisette G. Capelle
- Department of Gastroenterology and Hepatology, Meander Medical Center, 3813 Amersfoort, The Netherlands;
| | - Emilija Nikolovska Trpchevska
- Department of Gastroenterology, University Clinic for Gastroenterohepatology, 1000 Skopje, North Macedonia;
- Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 1000 Skopje, North Macedonia
| | - Leticia Moreira
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain; (Á.L.); (S.J.M.-D.); (L.B.); (L.M.)
- Hospital Clínic de Barcelona, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Anna Cano-Català
- Gastrointestinal Oncology, Endoscopy and Surgery (GOES) Research Group, Althaia Xarxa Assistencial Universitària de Manresa, 08243 Barcelona, Spain;
- Institut de Recerca i Innovació en Ciències de la Vida i de la Salut de la Catalunya Central (IRIS-CC), 08500 Barcelona, Spain
| | - Pablo Parra
- Digestive System Service of the Hospital Universitario de La Princesa, 28006 Madrid, Spain; (O.P.N.); (P.P.); (J.P.G.)
- Instituto de Investigación Sanitaria Princesa (IIS-Princesa), 28006 Madrid, Spain
- Departamento de Medicina, Universidad Autónoma de Madrid (UAM), 28049 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain; (Á.L.); (S.J.M.-D.); (L.B.); (L.M.)
| | - Francis Mégraud
- INSERM, Institut National de la Santé Et de la Recherche Médicale U1312, Université de Bordeaux, 33077 Bordeaux, France;
| | - Colm O’Morain
- School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland; (S.M.S.); (C.O.)
| | - Guillermo J. Ortega
- Unidad de Análisis de Datos del Instituto de Investigación Sanitaria Princesa (IIS-Princesa), 28006 Madrid, Spain;
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires C1425FQB, Argentina
- Science and Technology and Department, Universidad Nacional de Quilmes, Bernal B1876, Argentina
| | - Javier P. Gisbert
- Digestive System Service of the Hospital Universitario de La Princesa, 28006 Madrid, Spain; (O.P.N.); (P.P.); (J.P.G.)
- Instituto de Investigación Sanitaria Princesa (IIS-Princesa), 28006 Madrid, Spain
- Departamento de Medicina, Universidad Autónoma de Madrid (UAM), 28049 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain; (Á.L.); (S.J.M.-D.); (L.B.); (L.M.)
| | | |
Collapse
|
5
|
García-Morales N, Pérez-Aísa Á, Fiorini G, Tepes B, Castro-Fernández M, Lucendo A, Voynovan I, Bujanda L, Garre A, Rodrigo L, Martínez Domínguez SJ, Denkovski M, Huguet Malavés JM, Jonaitis L, Bumane R, Zaytsev O, Mata Romero P, Barrio J, Fernández-Salazar L, Sarsenbaeva AS, Ortiz Polo I, Alekseenko S, Saracino IM, Vaira D, Keco-Huerga A, Bordin D, Gasbarrini A, Lerang F, Rokkas T, Kupčinskas J, Leja M, Babayeva G, Marcos Pinto R, Tonkić A, Smith S, Phull P, Buzas GM, Simsek H, Boltin D, Gridnyev O, Venerito M, Milivojevic V, Torà N, Cano-Català A, Moreira L, Nyssen OP, Mégraud F, O'Morain C, Gisbert JP, Puig I. Helicobacter pylori Diagnostic Tests Used in Europe: Results of over 34,000 Patients from the European Registry on Helicobacter pylori Management. J Clin Med 2023; 12:4363. [PMID: 37445399 DOI: 10.3390/jcm12134363] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND AND AIMS Several methods are available to diagnose Helicobacter pylori infection. Our objective was to evaluate the tests used for both the initial diagnosis and the confirmation of eradication after treatment in Europe. METHODS The European Registry on the management of Helicobacter pylori infection is an international, multicentre, prospective, non-interventional registry aiming to evaluate the management of Helicobacter pylori-infected patients in Europe. Countries with at least 100 cases registered from June 2013 to April 2021, and with a validated diagnostic method were analysed. Data were quality reviewed. RESULTS A total of 34,920 adult patients from 20 countries were included (mean age 51 years; 61% women). To establish the initial diagnosis, invasive tests were performed in 19,801 (71%) patients, non-invasive in 11,369 (41%), and both in 3437 (12%). The most frequent were histology (n = 11,885; 43%), a rapid urease test (n = 10,636; 38%) and an urea breath test (n = 7577; 27%). According to the age, invasive tests were indicated in 11,179 (77%) ≥50 years, and in 8603 (65%) <50 years. Depending on the country, the use of invasive tests ranged from 29-99% in <50 years to 60-99% in ≥50. Most of the tests used to confirm eradication were non-invasive (n = 32,540; 93%), with the urea breath test being the most frequent (n = 32,540; 78%). In 2983 (9%) post-treatment tests, histology (n = 1887; 5%) or a rapid urease test (n = 1223; 4%) were performed. CONCLUSION A great heterogeneity was observed for the initial diagnosis and confirmation of the eradication. The reasons for the apparent lack of adherence to the clinical guidelines should be further explored.
Collapse
Affiliation(s)
- Natalia García-Morales
- Digestive Service, Complexo Hospitalario Universitario de Vigo, Sergas, South Galicia Health Research Institute, 36312 Vigo, Spain
| | - Ángeles Pérez-Aísa
- Unidad de Digestivo, Hospital Costa del Sol Marbella, Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), 29603 Marbella, Spain
| | - Giulia Fiorini
- Department of Surgical and Medical Sciences, IRCCS AOU S. Orsola, 39015 Bologna, Italy
| | - Bojan Tepes
- AM DC Rogaska, 3250 Rogaska Slatina, Slovenia
| | | | | | - Irina Voynovan
- A.S. Loginov, Clinical Scientific Centre, 111123 Moscow, Russia
| | - Luis Bujanda
- Department of Gastroenterology, Biodonostia Health Research Institute, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), 20014 San Sebastián, Spain
| | - Ana Garre
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain
| | - Luis Rodrigo
- Hospital Central de Asturias, 33011 Oviedo, Spain
| | - Samuel Jesús Martínez Domínguez
- Hospital Clínico Lozano Blesa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 50009 Zaragoza, Spain
| | | | | | - Laimas Jonaitis
- Department of Gastroenterology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Renate Bumane
- Digestive Diseases Centre GASTRO, LV-1006 Riga, Latvia
| | - Oleg Zaytsev
- First Clinical Medical Centre, 601900 Kovrov, Russia
| | | | | | | | | | | | | | - Ilaria Maria Saracino
- Department of Surgical and Medical Sciences, IRCCS AOU S. Orsola, 39015 Bologna, Italy
| | - Dino Vaira
- Department of Surgical and Medical Sciences, IRCCS AOU S. Orsola, 39015 Bologna, Italy
| | | | - Dmitry Bordin
- Gastroenterology Unit, A.S. Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia
- Gastroenterology Unit, Department of Outpatient Therapy and Family Medicine, Tver State Medical University, 170100 Tver, Russia
- Gastroenterology Unit, Department of Propaedeutic of Internal and Gastroenterology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, 127473 Moscow, Russia
| | - Antonio Gasbarrini
- Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Frode Lerang
- Central Hospital of Ostfold, 1601 Fredrikstad, Norway
| | | | - Juozas Kupčinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Marcis Leja
- Digestive Diseases Centre GASTRO, LV-1006 Riga, Latvia
| | | | | | - Ante Tonkić
- Department Gastroenterol & Hepatol, University Hospital Centre Split, 2100 Split, Croatia
| | | | | | - Gyorgy M Buzas
- Gastroenterology, Ferencváros Health Centre, Mester utca 45, 1095 Budapest, Hungary
| | - Halis Simsek
- Internal Med Gastroenterol Department, Hacettepe University School of Medicine, 06230 Ankara, Turkey
| | - Doron Boltin
- Division of Gastroenterology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 4941492, Israel
| | - Oleksiy Gridnyev
- L.T. Malaya Therapy National Institute of the National Academy of Medical Sciences, ID 70483 Kharkiv, Ukraine
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, 44, 39120 Magdeburg, Germany
| | | | - Núria Torà
- GOES Research Group, Unitat de Recerca i Innovació, Athaia Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain
| | - Anna Cano-Català
- GOES Research Group, Unitat de Recerca i Innovació, Athaia Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain
| | - Leticia Moreira
- Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERed), 08036 Barcelona, Spain
| | - Olga P Nyssen
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain
| | - Francis Mégraud
- INSERM U1312, Université de Bordeaux, 33000 Bordeaux, France
| | - Colm O'Morain
- Rabin Medical Center, Beilinson Campus, Petah Tikva 49100, Israel
| | - Javier P Gisbert
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain
| | - Ignasi Puig
- Althaia Xarxa Assistencial Universitària de Manresa and Universitat de Vic-Universitat Central de Catalunya (UVicUCC), 08242 Manresa, Spain
| |
Collapse
|
6
|
García-Morales N, Pérez-Aísa Á, Fiorini G, Tepes B, Castro-Fernández M, Lucendo A, Voynovan I, Bujanda L, Garre A, Rodrigo L, Martínez Domínguez SJ, Denkovski M, Huguet Malavés JM, Jonaitis L, Bumane R, Zaytsev O, Mata Romero P, Barrio J, Fernández-Salazar L, Sarsenbaeva AS, Ortiz Polo I, Alekseenko S, Saracino IM, Vaira D, Keco-Huerga A, Bordin D, Gasbarrini A, Lerang F, Rokkas T, Kupčinskas J, Leja M, Babayeva G, Marcos Pinto R, Tonkić A, Smith S, Phull P, Buzas GM, Simsek H, Boltin D, Gridnyev O, Venerito M, Milivojevic V, Torà N, Cano-Català A, Moreira L, Nyssen OP, Mégraud F, O’Morain C, Gisbert JP, Puig I. Helicobacter pylori Diagnostic Tests Used in Europe: Results of over 34,000 Patients from the European Registry on Helicobacter pylori Management. J Clin Med 2023; 12:4363. [DOI: https:/doi.org/10.3390/jcm12134363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Background and aims: Several methods are available to diagnose Helicobacter pylori infection. Our objective was to evaluate the tests used for both the initial diagnosis and the confirmation of eradication after treatment in Europe. Methods: The European Registry on the management of Helicobacter pylori infection is an international, multicentre, prospective, non-interventional registry aiming to evaluate the management of Helicobacter pylori-infected patients in Europe. Countries with at least 100 cases registered from June 2013 to April 2021, and with a validated diagnostic method were analysed. Data were quality reviewed. Results: A total of 34,920 adult patients from 20 countries were included (mean age 51 years; 61% women). To establish the initial diagnosis, invasive tests were performed in 19,801 (71%) patients, non-invasive in 11,369 (41%), and both in 3437 (12%). The most frequent were histology (n = 11,885; 43%), a rapid urease test (n = 10,636; 38%) and an urea breath test (n = 7577; 27%). According to the age, invasive tests were indicated in 11,179 (77%) ≥50 years, and in 8603 (65%) <50 years. Depending on the country, the use of invasive tests ranged from 29–99% in <50 years to 60–99% in ≥50. Most of the tests used to confirm eradication were non-invasive (n = 32,540; 93%), with the urea breath test being the most frequent (n = 32,540; 78%). In 2983 (9%) post-treatment tests, histology (n = 1887; 5%) or a rapid urease test (n = 1223; 4%) were performed. Conclusion: A great heterogeneity was observed for the initial diagnosis and confirmation of the eradication. The reasons for the apparent lack of adherence to the clinical guidelines should be further explored.
Collapse
Affiliation(s)
- Natalia García-Morales
- Digestive Service, Complexo Hospitalario Universitario de Vigo, Sergas, South Galicia Health Research Institute, 36312 Vigo, Spain
| | - Ángeles Pérez-Aísa
- Unidad de Digestivo, Hospital Costa del Sol Marbella, Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), 29603 Marbella, Spain
| | - Giulia Fiorini
- Department of Surgical and Medical Sciences, IRCCS AOU S. Orsola, 39015 Bologna, Italy
| | - Bojan Tepes
- AM DC Rogaska, 3250 Rogaska Slatina, Slovenia
| | | | | | - Irina Voynovan
- A.S. Loginov, Clinical Scientific Centre, 111123 Moscow, Russia
| | - Luis Bujanda
- Department of Gastroenterology, Biodonostia Health Research Institute, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), 20014 San Sebastián, Spain
| | - Ana Garre
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain
| | - Luis Rodrigo
- Hospital Central de Asturias, 33011 Oviedo, Spain
| | - Samuel Jesús Martínez Domínguez
- Hospital Clínico Lozano Blesa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 50009 Zaragoza, Spain
| | | | | | - Laimas Jonaitis
- Department of Gastroenterology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Renate Bumane
- Digestive Diseases Centre GASTRO, LV-1006 Riga, Latvia
| | - Oleg Zaytsev
- First Clinical Medical Centre, 601900 Kovrov, Russia
| | | | | | | | | | | | | | - Ilaria Maria Saracino
- Department of Surgical and Medical Sciences, IRCCS AOU S. Orsola, 39015 Bologna, Italy
| | - Dino Vaira
- Department of Surgical and Medical Sciences, IRCCS AOU S. Orsola, 39015 Bologna, Italy
| | | | - Dmitry Bordin
- Gastroenterology Unit, A.S. Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia
- Gastroenterology Unit, Department of Outpatient Therapy and Family Medicine, Tver State Medical University, 170100 Tver, Russia
- Gastroenterology Unit, Department of Propaedeutic of Internal and Gastroenterology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, 127473 Moscow, Russia
| | - Antonio Gasbarrini
- Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Frode Lerang
- Central Hospital of Ostfold, 1601 Fredrikstad, Norway
| | | | - Juozas Kupčinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Marcis Leja
- Digestive Diseases Centre GASTRO, LV-1006 Riga, Latvia
| | | | | | - Ante Tonkić
- Department Gastroenterol & Hepatol, University Hospital Centre Split, 2100 Split, Croatia
| | | | | | - Gyorgy M. Buzas
- Gastroenterology, Ferencváros Health Centre, Mester utca 45, 1095 Budapest, Hungary
| | - Halis Simsek
- Internal Med Gastroenterol Department, Hacettepe University School of Medicine, 06230 Ankara, Turkey
| | - Doron Boltin
- Division of Gastroenterology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 4941492, Israel
| | - Oleksiy Gridnyev
- L.T. Malaya Therapy National Institute of the National Academy of Medical Sciences, ID 70483 Kharkiv, Ukraine
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, 44, 39120 Magdeburg, Germany
| | | | - Núria Torà
- GOES Research Group, Unitat de Recerca i Innovació, Athaia Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain
| | - Anna Cano-Català
- GOES Research Group, Unitat de Recerca i Innovació, Athaia Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain
| | - Leticia Moreira
- Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERed), 08036 Barcelona, Spain
| | - Olga P. Nyssen
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain
| | - Francis Mégraud
- INSERM U1312, Université de Bordeaux, 33000 Bordeaux, France
| | - Colm O’Morain
- Rabin Medical Center, Beilinson Campus, Petah Tikva 49100, Israel
| | - Javier P. Gisbert
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain
| | - Ignasi Puig
- Althaia Xarxa Assistencial Universitària de Manresa and Universitat de Vic-Universitat Central de Catalunya (UVicUCC), 08242 Manresa, Spain
| | | |
Collapse
|
7
|
Burgos-Santamaría D, Nyssen OP, Gasbarrini A, Vaira D, Pérez-Aisa Á, Rodrigo L, Pellicano R, Keco-Huerga A, Pabón-Carrasco M, Castro-Fernandez M, Boltin D, Barrio J, Phull P, Kupcinskas J, Jonaitis L, Ortiz-Polo I, Tepes B, Lucendo AJ, Huguet JM, Areia M, Jurecic NB, Denkovski M, Bujanda L, Ramos-San Román J, Cuadrado-Lavín A, Gomez-Camarero J, Jiménez Moreno MA, Lanas A, Martinez-Dominguez SJ, Alfaro E, Marcos-Pinto R, Milivojevic V, Rokkas T, Leja M, Smith S, Tonkić A, Buzás GM, Doulberis M, Venerito M, Lerang F, Bordin DS, Lamy V, Capelle LG, Marlicz W, Dobru D, Gridnyev O, Puig I, Mégraud F, O'Morain C, Gisbert JP. Empirical rescue treatment of Helicobacter pylori infection in third and subsequent lines: 8-year experience in 2144 patients from the European Registry on H. pylori management (Hp-EuReg). Gut 2022; 72:gutjnl-2022-328232. [PMID: 36591610 DOI: 10.1136/gutjnl-2022-328232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/06/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate the use, effectiveness and safety of Helicobacter pylori empirical rescue therapy in third and subsequent treatment lines in Europe. DESIGN International, prospective, non-interventional registry of the clinical practice of European gastroenterologists. Data were collected and quality reviewed until October 2021 at Asociación Española de Gastroenterología-Research Electronic Data Capture. All cases with three or more empirical eradication attempts were assessed for effectiveness by modified intention-to-treat and per-protocol analysis. RESULTS Overall, 2144 treatments were included: 1519, 439, 145 and 41 cases from third, fourth, fifth and sixth treatment lines, respectively. Sixty different therapies were used; the 15 most frequently prescribed encompassed >90% of cases. Overall effectiveness remained <90% in all therapies. Optimised treatments achieved a higher eradication rate than non-optimised (78% vs 67%, p<0.0001). From 2017 to 2021, only 44% of treatments other than 10-day single-capsule therapy used high proton-pump inhibitor doses and lasted ≥14 days. Quadruple therapy containing metronidazole, tetracycline and bismuth achieved optimal eradication rates only when prescribed as third-line treatment, either as 10-day single-capsule therapy (87%) or as 14-day traditional therapy with tetracycline hydrochloride (95%). Triple amoxicillin-levofloxacin therapy achieved 90% effectiveness in Eastern Europe only or when optimised. The overall incidence of adverse events was 31%. CONCLUSION Empirical rescue treatment in third and subsequent lines achieved suboptimal effectiveness in most European regions. Only quadruple bismuth-metronidazole-tetracycline (10-day single-capsule or 14-day traditional scheme) and triple amoxicillin-levofloxacin therapies reached acceptable outcomes in some settings. Compliance with empirical therapy optimisation principles is still poor 5 years after clinical practice guidelines update. TRIAL REGISTRATION NUMBER NCT02328131.
Collapse
Affiliation(s)
- Diego Burgos-Santamaría
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Enfermedades Hepáticas y Digestivas, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Olga P Nyssen
- Gastroenterology Unit, Hospital Universitario de la Princesa, Madrid, Spain
- Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
- Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Antonio Gasbarrini
- Internal Medicine, Gastroenterology and Liver Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Italy
| | - Dino Vaira
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Ángeles Pérez-Aisa
- Department of Gastroenterology, Hospital Costa del Sol Marbella, Marbella, Spain
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Marbella, Spain
| | - Luís Rodrigo
- Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Rinaldo Pellicano
- Outpatient Clinic, Molinette-SGAS Hospital, University of Turin, Turin, Italy
| | | | | | - Manuel Castro-Fernandez
- Hospital Universitario Virgen de Valme, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Sevilla, Spain
| | - Doron Boltin
- Department of Gastroenterology, Rabin Medical Center, Beilinson Campus, Tel Aviv University, Petach Tikva, Israel
| | - Jesus Barrio
- Department of Gastroenterology, Hospital Rio Hortega, Valladolid, Spain
| | | | - Juozas Kupcinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Laimas Jonaitis
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Inmaculada Ortiz-Polo
- Department of Gastroenterology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Bojan Tepes
- Department of Gastroenterology, AM DC Rogaska, Rogaska Slatina, Slovenia
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain
| | - José María Huguet
- Gastroenterology Unit, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Miguel Areia
- Francisco Gentil Portuguese Institute for Oncology of Coimbra, Coimbra, Portugal
| | | | | | - Luís Bujanda
- Department of Gastroenterology, Hospital Universitario de Donostia, San Sebastian, Spain
- Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), San Sebastián, Spain
| | - June Ramos-San Román
- Department of Gastroenterology, Hospital Universitario de Donostia, San Sebastian, Spain
| | - Antonio Cuadrado-Lavín
- Department of Gastroenterology and Hepatology, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | | | | | - Angel Lanas
- Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Enrique Alfaro
- Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Ricardo Marcos-Pinto
- Department of Gastroenterology, Centro Hospitalar do Porto, Porto, Portugal
- CINTESIS, University of Porto Institute of Biomedical Sciences Abel Salazar, Porto, Portugal
| | - Vladimir Milivojevic
- University Clinical Center of Serbia Clinic for Gastroenterology and Hepatology, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Theodore Rokkas
- Department of Gastroenterology, Henry Dunant Hospital Center, Athens, Greece
| | - Marcis Leja
- Digestive Disease Center GASTRO, Institute of Clinical and Preventive Medicine, Riga, Latvia
- University of Latvia Faculty of Medicine, Riga, Latvia
| | - Sinead Smith
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Ante Tonkić
- Department of Gastroenterology, University Hospital Center Split Križine, Split, Croatia
| | - György Miklós Buzás
- Department of Gastroenterology, Ferencváros Health Centre, Budapest, Hungary
| | - Michael Doulberis
- Division of Gastroenterology and Hepatology, Kantonsspital Aarau AG, Aarau, Switzerland
- Department of Gastroenterology and Hepatology, University of Zurich, Zurich, Switzerland
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
| | - Frode Lerang
- Department of Gastroenterololgy, Ostfold Hospital, Gralum, Norway
| | - Dmitry S Bordin
- Department of Pancreatic, Biliary and Upper Digestive Tract disorders, AS Loginov Moscow Clinical Scientific Center, Moscow, Russian Federation
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
| | | | - Lisette G Capelle
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Daniela Dobru
- Department of Gastroenterology, University of Medicine, Pharmacy, Science, and Technology of Târgu Mures, Târgu Mures, Romania
| | | | - Ignasi Puig
- Department of Digestive Diseases, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain
- Universitat de Vic-Universitat Central de Catalunya (UVicUCC), Manresa, Spain
| | | | - Colm O'Morain
- Department of Gastroenterology, Trinity College Dublin, Dublin, Ireland
| | - Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de la Princesa, Madrid, Spain
- Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
- Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| |
Collapse
|
8
|
Nyssen OP, Vaira D, Pérez Aísa Á, Rodrigo L, Castro-Fernandez M, Jonaitis L, Tepes B, Vologzhanina L, Caldas M, Lanas A, Lucendo AJ, Bujanda L, Ortuño J, Barrio J, Huguet JM, Voynovan I, Lasala JP, Sarsenbaeva AS, Fernandez-Salazar L, Molina-Infante J, Jurecic NB, Areia M, Gasbarrini A, Kupčinskas J, Bordin D, Marcos-Pinto R, Lerang F, Leja M, Buzas GM, Niv Y, Rokkas T, Phull P, Smith S, Shvets O, Venerito M, Milivojevic V, Simsek I, Lamy V, Bytzer P, Boyanova L, Kunovský L, Beglinger C, Doulberis M, Marlicz W, Goldis A, Tonkić A, Capelle L, Puig I, Megraud F, Morain CO, Gisbert JP. Empirical Second-Line Therapy in 5000 Patients of the European Registry on Helicobacter pylori Management (Hp-EuReg). Clin Gastroenterol Hepatol 2022; 20:2243-2257. [PMID: 34954341 DOI: 10.1016/j.cgh.2021.12.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/14/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS After a first Helicobacter pylori eradication attempt, approximately 20% of patients will remain infected. The aim of the current study was to assess the effectiveness and safety of second-line empiric treatment in Europe. METHODS This international, multicenter, prospective, non-interventional registry aimed to evaluate the decisions and outcomes of H pylori management by European gastroenterologists. All infected adult cases with a previous eradication treatment attempt were registered with the Spanish Association of Gastroenterology-Research Electronic Data Capture until February 2021. Patients allergic to penicillin and those who received susceptibility-guided therapy were excluded. Data monitoring was performed to ensure data quality. RESULTS Overall, 5055 patients received empiric second-line treatment. Triple therapy with amoxicillin and levofloxacin was prescribed most commonly (33%). The overall effectiveness was 82% by modified intention-to-treat analysis and 83% in the per-protocol population. After failure of first-line clarithromycin-containing treatment, optimal eradication (>90%) was obtained with moxifloxacin-containing triple therapy or levofloxacin-containing quadruple therapy (with bismuth). In patients receiving triple therapy containing levofloxacin or moxifloxacin, and levofloxacin-bismuth quadruple treatment, cure rates were optimized with 14-day regimens using high doses of proton pump inhibitors. However, 3-in-1 single capsule or levofloxacin-bismuth quadruple therapy produced reliable eradication rates regardless of proton pump inhibitor dose, duration of therapy, or previous first-line treatment. The overall incidence of adverse events was 28%, and most (85%) were mild. Three patients developed serious adverse events (0.3%) requiring hospitalization. CONCLUSIONS Empiric second-line regimens including 14-day quinolone triple therapies, 14-day levofloxacin-bismuth quadruple therapy, 14-day tetracycline-bismuth classic quadruple therapy, and 10-day bismuth quadruple therapy (as a single capsule) provided optimal effectiveness. However, many other second-line treatments evaluated reported low eradication rates. ClincialTrials.gov number: NCT02328131.
Collapse
Affiliation(s)
- Olga P Nyssen
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Dino Vaira
- Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - Ángeles Pérez Aísa
- Department of Gastroenterology, Agencia Sanitaria Costa del Sol, Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Marbella, Spain
| | - Luis Rodrigo
- Department of Gastroenterology, Hospital de Asturias, Oviedo, Spain
| | | | - Laimas Jonaitis
- Department of Gastroenterology, Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Bojan Tepes
- Department of Gastroenterology, AM DC Rogaska, Rogaska Slatina, Slovenia
| | | | - María Caldas
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Angel Lanas
- Department of Gastroenterology, Hospital Clínico Universitario/Instituto de Investigacion Sanitaria Aragón, University of Zaragoza, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Zaragoza, Spain
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain
| | - Luis Bujanda
- Department of Gastroenterology, Hospital Donostia/Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Universidad del País Vasco, San Sebastián, Spain
| | - Juan Ortuño
- Department of Gastroenterology, Hospital Universitari i Politècnic, La Fe, Valencia, Spain
| | - Jesús Barrio
- Department of Gastroenterology, Hospital Río Hortega, Valladolid, Spain
| | - Jose M Huguet
- Department of Gastroenterology, Hospital General Universitario de Valencia, Valencia, Spain
| | - Irina Voynovan
- Department of Gastroenterology, A.S. Loginov Moscow Clinical Scientific Center, Moscow, Russia
| | | | | | | | | | | | - Miguel Areia
- Department of Gastroenterology, Portuguese Oncology Institute Coimbra, Coimbra, Portugal
| | - Antonio Gasbarrini
- Medicina Interna, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Juozas Kupčinskas
- Department of Gastroenterology, Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dmitry Bordin
- Department of Gastroenterology, A.S. Loginov Moscow Clinical Scientific Center, Moscow, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Tver State Medical University, Tver, Russia
| | - Ricardo Marcos-Pinto
- Department of Gastroenterology, Centro Hospitalar do Porto Institute of Biomedical Sciences Abel Salazar, Centro de Investigação em Tecnologias e Serviços de Saúde, University of Porto, Porto, Portugal
| | - Frode Lerang
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway
| | - Marcis Leja
- Department of Gastroenterology, Digestive Diseases Centre Gastro, Institute of Clinical and Preventive Medicine and Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Gyorgy M Buzas
- Department of Gastroenterology, Ferencváros Health Centre, Budapest, Hungary
| | - Yaron Niv
- Department of Gastroenterology, Rabin Medical Center, Tel Aviv University, Petah Tikva, Israel
| | - Theodore Rokkas
- Department of Gastroenterology, Henry Dunant Hospital, Athens, Greece
| | - Perminder Phull
- Department of Gastroenterology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Sinead Smith
- Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Oleg Shvets
- Department of Gastroenterology, Internal Medicine, National Medical University, Kyiv, Ukraine
| | - Marino Venerito
- Department of Gastroenterology, Otto-von-Guericke University, Magdeburg, Germany
| | - Vladimir Milivojevic
- Department of Gastroenterology, Clinical Center of Serbia, University of Belgrade School of Medicine, Belgrade, Serbia
| | - Ilkay Simsek
- Department of Gastroenterology, Internal Medicine, Hacettepe, University School of Medicine, Ankara, Turkey
| | - Vincent Lamy
- Department of Gastroenterology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Peter Bytzer
- Department of Gastroenterology, Clinical Medicine, Zealand University Hospital, Copenhagen University, Copenhagen, Denmark
| | - Lyudmila Boyanova
- Department of Gastroenterology, Medical Microbiology, Medical University of Sofia, Sofia, Bulgaria
| | - Lumír Kunovský
- Department of Gastroenterology and Internal Medicine, Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Michael Doulberis
- Emergency Department, University Hospital Inselspital of Bern, Bern, Switzerland, Second Medical Clinic, School of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Macedonia, Greece, and First Laboratory of Pharmacology, Aristotle University of Thessaloniki, Thessaloniki, Macedonia, Greece
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Adrian Goldis
- Department of Gastroenterology, Timisoara Hospital, Timisoara, Romania
| | - Ante Tonkić
- Department of Gastroenterology, University Hospital of Split, University of Split School of Medicine, Split, Croatia
| | - Lisette Capelle
- Department of Gastroenterology, Meander Medical Center, Amersfoort, The Netherlands
| | - Ignasi Puig
- Department of Gastroenterology, Althaia Xarxa Assistencial Universitària de Manresa, Universitat de Vic-Universitat Central de Catalunya, Manresa, Spain
| | - Francis Megraud
- Institut national de la santé et de la recherche médicale (INSERM) U1312 BRIC Team 4, University of Bordeaux, Bordeaux, France
| | - Colm O' Morain
- Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Javier P Gisbert
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain.
| | | |
Collapse
|
9
|
Lerang F, Holst R, Henriksen M, Wåhlberg H, Jelsness-Jørgensen LP. Antitumour necrosis factor alpha treatment in Crohn's disease: long-term efficacy, side effects and need for surgery. Scand J Gastroenterol 2022; 57:921-929. [PMID: 35188443 DOI: 10.1080/00365521.2022.2042592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To examine the long-term efficacy and side effects of antitumour necrosis factor alpha (anti-TNF) therapy in patients with Crohn's disease (CD), the need for surgery and the clinical outcome after discontinuing anti-TNF therapy. MATERIAL AND METHODS Data were collected from the inflammatory bowel disease (IBD)-TNF register at Østfold Hospital Trust. Clinical and sociodemographic data were recorded for patients initiating anti-TNF therapy from January 2000 until December 2011. Follow-up was conducted until December 2017. RESULTS Complete remission (CR) was achieved in 40/154 (26%) patients at the last follow-up (median follow-up time 10 years). A total of 40 (26%) patients had to discontinue treatment due to serious side effects, and malignancy was recorded in 10 (6.5%) patients. Surgical resection was performed in 55 (36%) patients during follow-up. Patients with Montreal phenotype B2 before anti-TNF therapy were estimated to have a 2.54-fold greater risk of surgery than patients with phenotype B1 (p = .001). Of those with phenotype B1 before anti-TNF therapy, 19 (24%) of them developed stenosis in need of surgical resection ('phenotype migration'). In patients followed up after discontinuing anti-TNF therapy (n = 89, median observational time six years), CR was achieved in most patients. CONCLUSIONS Long-term complete remission was achieved in only one in four patients receiving anti-TNF therapy, and one in four patients had to discontinue therapy due to side effects. Despite anti-TNF therapy, one in four patients with a baseline luminal disease phenotype needed subsequent surgical resection.
Collapse
Affiliation(s)
- Frode Lerang
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway
| | - René Holst
- Department of Research, Østfold Hospital Trust, Grålum, Norway.,Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Magne Henriksen
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway
| | - Henrik Wåhlberg
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway
| | | |
Collapse
|
10
|
Romstad KK, Detlie TE, Søberg T, Thomas O, Ricanek P, Jahnsen ME, Lerang F, Jahnsen J. Treatment and outcome of gastrointestinal bleeding due to peptic ulcers and erosions - (BLUE study). Scand J Gastroenterol 2022; 57:8-15. [PMID: 34663154 DOI: 10.1080/00365521.2021.1988701] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Peptic ulcers and erosions are the most common causes of upper gastrointestinal bleeding. The aim of this study was to investigate the management and outcomes of these patients. MATERIALS AND METHODS A total of 543 patients with endoscopically confirmed bleeding from peptic ulcers and erosions were included from March 2015 to December 2017. The patient characteristics, endoscopic findings, Forrest classification and endoscopic treatment were recorded. Moreover, the rebleeding rates, repeated endoscopies and transcatheter angiographic embolization and surgery incidences were registered. A follow-up endoscopy after discharge from the hospital was scheduled. RESULTS Among the patients, high-risk stigmata ulcers were present in 36% (198/543) and low-risk stigmata ulcers and erosions in 60% (327/543) at first endoscopy. Endoscopic therapy was performed in 30% (165/543) of the patients, and hemostasis was achieved in 94% (155/165). The incidence of rebleeding was 9% (49/543) for the whole cohort and 14.8% (23/155) for those patients who had received successful endoscopic treatment. Moreover, rebleeding was significantly more frequent in duodenal ulcers than in gastric ulcers (11.9% vs 4.0%, p = .004). In a multivariable analysis, rebleeding was significantly related to comorbidity and Forrest classification. Transcatheter angiographic embolization and surgery were required in 6% (34/543) and 0.07% (4/543) of patients, respectively. Complete peptic ulcer healing was found at follow-up in 73.3% (270/368) of patients. CONCLUSIONS Endoscopic hemostasis was achieved in the majority of patients with high-risk ulceration, although the occurrence of rebleeding is a significant challenge, especially in patients with duodenal ulcers. Clinical trial registration: Bleeding Ulcer and Erosions Study (BLUE Study), ClinicalTrials.gov identifier: NCT03367897.
Collapse
Affiliation(s)
- Katrine Kauczynska Romstad
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trond Espen Detlie
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Taran Søberg
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway
| | - Owen Thomas
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Petr Ricanek
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Marte Eide Jahnsen
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Frode Lerang
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway
| | - Jørgen Jahnsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| |
Collapse
|
11
|
Nyssen OP, Perez-Aisa A, Tepes B, Castro-Fernandez M, Kupcinskas J, Jonaitis L, Bujanda L, Lucendo A, Jurecic NB, Perez-Lasala J, Shvets O, Fadeenko G, Huguet JM, Kikec Z, Bordin D, Voynovan I, Leja M, Machado JC, Areia M, Fernandez-Salazar L, Rodrigo L, Alekseenko S, Barrio J, Ortuño J, Perona M, Vologzhanina L, Romero PM, Zaytsev O, Rokkas T, Georgopoulos S, Pellicano R, Buzas GM, Modolell I, Gomez Rodriguez BJ, Simsek I, Simsek C, Lafuente MR, Ilchishina T, Camarero JG, Dominguez-Cajal M, Ntouli V, Dekhnich NN, Phull P, Nuñez O, Lerang F, Venerito M, Heluwaert F, Tonkic A, Caldas M, Puig I, Megraud F, O'Morain C, Gisbert JP. Adverse Event Profile During the Treatment of Helicobacter pylori: A Real-World Experience of 22,000 Patients From the European Registry on H. pylori Management (Hp-EuReg). Am J Gastroenterol 2021; 116:1220-1229. [PMID: 33840725 DOI: 10.14309/ajg.0000000000001246] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 02/23/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The safety of Helicobacter pylori eradication treatments and to what extent adverse events (AEs) influence therapeutic compliance in clinical practice are hardly known. Our aim was to assess the frequency, type, intensity, and duration of AEs, and their impact on compliance, for the most frequently used treatments in the "European Registry on Helicobacter pylori management." METHODS Systematic prospective noninterventional registry of the clinical practice of European gastroenterologists (27 countries, 300 investigators) on the management of H. pylori infection in routine clinical practice. All prescribed eradication treatments and their corresponding safety profile were recorded. AEs were classified depending on the intensity of symptoms as mild/moderate/severe and as serious AEs. All data were subject to quality control. RESULTS The different treatments prescribed to 22,492 patients caused at least 1 AE in 23% of the cases; the classic bismuth-based quadruple therapy was the worst tolerated (37% of AEs). Taste disturbance (7%), diarrhea (7%), nausea (6%), and abdominal pain (3%) were the most frequent AEs. The majority of AEs were mild (57%), 6% were severe, and only 0.08% were serious, with an average duration of 7 days. The treatment compliance rate was 97%. Only 1.3% of the patients discontinued treatment due to AEs. Longer treatment durations were significantly associated with a higher incidence of AEs in standard triple, concomitant, bismuth quadruple, and levofloxacin triple or quadruple therapies. DISCUSSION Helicobacter pylori eradication treatment frequently induces AEs, although they are usually mild and of limited duration. Their appearance does not interfere significantly with treatment compliance.
Collapse
Affiliation(s)
- Olga P Nyssen
- 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), Madrid, Spain
| | - Angeles Perez-Aisa
- Gastroenterology Unit, Agencia Sanitaria Costa del Sol, Marbella, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Málaga, Spain
| | - Bojan Tepes
- Gastroenterology Unit, AM DC Rogaska, Rogaska Slatina, Slovenia
| | | | - Juozas Kupcinskas
- Gastroenterology Unit, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Laimas Jonaitis
- Gastroenterology Unit, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Luis Bujanda
- Gastroenterology Unit, Hospital Donostia/Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | - Alfredo Lucendo
- Gastroenterology Unit, Hospital de Tomelloso, Ciudad Real, Spain
| | | | | | - Oleg Shvets
- Gastroenterology Unit, Internal Diseases Department No. 1, National Medical University named after O.O. Bogomolets, Kyiv, Ukraine
| | - Galina Fadeenko
- Gastroenterology Unit, National Ukrainian Academy of Medical Sciences, Ukraine
| | - Jose M Huguet
- Gastroenterology Unit, Consorci Hospital General Universitari Valencia, Spain
| | - Zdenki Kikec
- Gastroenterology Unit, Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
| | - Dmitry Bordin
- Gastroenterology Unit, A. S. Loginov Moscow Clinical Scientific Center, Moscow, Russia
- Gastroenterology Unit, Department of Outpatient Therapy and Family Medicine, Tver State Medical University, Tver, Russia
- Gastroenterology Unit, Department of Propaedeutic of Internal diseases and Gastroenterology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Irina Voynovan
- Gastroenterology Unit, A. S. Loginov Moscow Clinical Scientific Center, Moscow, Russia
| | - Marcis Leja
- Gastroenterology Unit, Digestive Diseases Center GASTRO, Riga, Latvia
| | - Jose Carlos Machado
- Gastroenterology Unit, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, and Ipatimup-Institute of Molecular Pathology and Immunology of the University of Porto, Portugal
| | - Miguel Areia
- Gastroenterology Unit, Portuguese Oncology Institute of Coimbra, Portugal
| | | | - Luis Rodrigo
- Gastroenterology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Sergey Alekseenko
- Gastroenterology Unit, Far Eastern State Medical University Khabarovsk, Russia
| | - Jesus Barrio
- Gastroenterology Unit, Hospital Rio Hortega, Valladolid, Spain
| | - Juan Ortuño
- Gastroenterology Unit, Hospital Universitari I Politècnic La Fe Valencia, Spain
| | - Monica Perona
- Gastroenterology Unit, Hospital Quiron Marbella, Spain
| | | | - Pilar Mata Romero
- Gastroenterology Unit, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Oleg Zaytsev
- Gastroenterology Unit, First Clinical Medical Center Kovrov, Russia
| | - Theodore Rokkas
- Gastroenterology Unit, Henry Dunant Hospital, Athens, Greece
| | - Sotirios Georgopoulos
- Gastroenterology Unit, Athens Medical Center, Paleo Faliron General Hospital Athens, Greece
| | | | - Gyorgy M Buzas
- Gastroenterology Unit, Ferencváros Policlinic, Budapest, Hungary
| | - Ines Modolell
- Gastroenterology Unit, Consorci Sanitari Terrassa, Spain
| | | | - Ilkay Simsek
- Gastroenterology Unit, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Cem Simsek
- Gastroenterology Unit, Hacettepe University Ankara, Turkey
| | | | | | | | | | | | | | - Perminder Phull
- Gastroenterology Unit, Aberdeen Royal Infirmary Aberdeen, United Kingdom
| | - Oscar Nuñez
- Gastroenterology Unit, Hospital Universitario Sanitas La Moraleja, Madrid, Spain
| | - Frode Lerang
- Gastroenterology Unit, Medical Department, Central Hospital Ostfold, Fredrikstad, Norway
| | - Marino Venerito
- Gastroenterology Unit, Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - Frederic Heluwaert
- Gastroenterology Unit, Center Hospitalier Annecy Genvois, Pringy, France
| | - Ante Tonkic
- Gastroenterology Unit, University Hospital of Split, School of Medicine, University of Split, Croatia
| | - Maria Caldas
- 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), Madrid, Spain
| | - Ignasi Puig
- Gastroenterology Unit, Althaia Xarxa Assistencial Universitària de Manresa and Universitat de Vic-Universitat Central de Catalunya (UVicUCC), Manresa, Spain
| | - Francis Megraud
- Gastroenterology Unit, Laboratoire de Bactériologie, Hôpital Pellegrin, Bordeaux, France
| | - Colm O'Morain
- Gastroenterology Unit, Department of Clinical Medicine, Trinity College Dublin, Ireland
| | - Javier P Gisbert
- 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), Madrid, Spain
| |
Collapse
|
12
|
Nyssen OP, Bordin D, Tepes B, Pérez-Aisa Á, Vaira D, Caldas M, Bujanda L, Castro-Fernandez M, Lerang F, Leja M, Rodrigo L, Rokkas T, Kupcinskas L, Pérez-Lasala J, Jonaitis L, Shvets O, Gasbarrini A, Simsek H, Axon ATR, Buzás G, Machado JC, Niv Y, Boyanova L, Goldis A, Lamy V, Tonkic A, Przytulski K, Beglinger C, Venerito M, Bytzer P, Capelle L, Milosavljević T, Milivojevic V, Veijola L, Molina-Infante J, Vologzhanina L, Fadeenko G, Ariño I, Fiorini G, Garre A, Garrido J, F Pérez C, Puig I, Heluwaert F, Megraud F, O'Morain C, Gisbert JP. European Registry on Helicobacter pylori management (Hp-EuReg): patterns and trends in first-line empirical eradication prescription and outcomes of 5 years and 21 533 patients. Gut 2021; 70:40-54. [PMID: 32958544 DOI: 10.1136/gutjnl-2020-321372] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/08/2020] [Accepted: 06/26/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The best approach for Helicobacter pylori management remains unclear. An audit process is essential to ensure clinical practice is aligned with best standards of care. DESIGN International multicentre prospective non-interventional registry starting in 2013 aimed to evaluate the decisions and outcomes in H. pylori management by European gastroenterologists. Patients were registered in an e-CRF by AEG-REDCap. Variables included demographics, previous eradication attempts, prescribed treatment, adverse events and outcomes. Data monitoring was performed to ensure data quality. Time-trend and geographical analyses were performed. RESULTS 30 394 patients from 27 European countries were evaluated and 21 533 (78%) first-line empirical H. pylori treatments were included for analysis. Pretreatment resistance rates were 23% to clarithromycin, 32% to metronidazole and 13% to both. Triple therapy with amoxicillin and clarithromycin was most commonly prescribed (39%), achieving 81.5% modified intention-to-treat eradication rate. Over 90% eradication was obtained only with 10-day bismuth quadruple or 14-day concomitant treatments. Longer treatment duration, higher acid inhibition and compliance were associated with higher eradication rates. Time-trend analysis showed a region-dependent shift in prescriptions including abandoning triple therapies, using higher acid-inhibition and longer treatments, which was associated with an overall effectiveness increase (84%-90%). CONCLUSION Management of H. pylori infection by European gastroenterologists is heterogeneous, suboptimal and discrepant with current recommendations. Only quadruple therapies lasting at least 10 days are able to achieve over 90% eradication rates. European recommendations are being slowly and heterogeneously incorporated into routine clinical practice, which was associated with a corresponding increase in effectiveness.
Collapse
Affiliation(s)
- Olga P Nyssen
- Gastroenterolgy Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Dmitry Bordin
- Department of Pancreatic, Biliary and Upper Digestive Tract Disorders, AS Loginov Moscow Clinical Scientific Center, Moscow, Russian Federation.,A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
| | - Bojan Tepes
- Gastroenterology, AM DC Rogaska, Rogaska Slatina, Slovenia
| | - Ángeles Pérez-Aisa
- Gastroenterology, Agencia Sanitaria Costa del Sol, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Marbella, Spain
| | - Dino Vaira
- Department of of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - Maria Caldas
- Gastroenterolgy Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Luis Bujanda
- Gastroenterology, Hospital Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), CIBEREHD, San Sebastian, Spain
| | | | - Frode Lerang
- Gastroenterololgy, Østfold Hospital Trust, Grålum, Norway
| | - Marcis Leja
- Digestive Diseases Centre GASTRO, Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Luís Rodrigo
- Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Limas Kupcinskas
- Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Laimas Jonaitis
- Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Oleg Shvets
- Internal Medicine, National Medical University named after O.O.Bogomolets, Kyiv, Ukraine
| | - Antonio Gasbarrini
- Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Halis Simsek
- Internal Medicine/Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - György Buzás
- Gastroenterology, Ferencváros Health Centre, Budapest, Hungary
| | - Jose Carlos Machado
- i3S - Instituto de Investigação e Inovação em Saúde. Medical Faculty of Porto. Universidade do Porto, Porto, Portugal
| | - Yaron Niv
- Gastroenterology, Rabin Medical Center, Tel Aviv University, Petah Tikva, Israel
| | | | - Adrian Goldis
- Gastroenterology, Timisoara Hospital, Timisoara, Romania
| | - Vincent Lamy
- Gastroenterology, Hepatology & Nutrition, CHU de Charleroi, Charleroi, Belgium
| | - Ante Tonkic
- Gastroenterology, University Hospital of Split, University of Split, Split, Croatia
| | | | | | - Marino Venerito
- Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
| | - Peter Bytzer
- Clinical Medicine, Zealand University Hospital, Copenhagen University, Copenhagen, Denmark
| | - Lisette Capelle
- Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, Netherlands
| | - Tomica Milosavljević
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia and School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladimir Milivojevic
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia and School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Lea Veijola
- Internal Medicine, Herttoniemi Hospital, Helsinki, Finland
| | | | | | - Galina Fadeenko
- Gastroenterology, Digestive Ukrainian Academy of Medical Sciences, Kyiv, Ukraine
| | - Ines Ariño
- Gastroenterology, Hospital Clinico Universitario Lozano Blesa, CIBEREHD, Zaragoza, Spain
| | - Giulia Fiorini
- Department of of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - Ana Garre
- Gastroenterolgy Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Jesús Garrido
- Departmento de Psicología Social y Metodología, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Cristina F Pérez
- Servicio de Medicina Preventiva, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ignasi Puig
- Gastroenterology, Althaia Xarxa Assistencial Universitària de Manresa and Universitat de Vic-Universitat Central de Catalunya (UVicUCC), Manresa, Spain
| | | | - Francis Megraud
- Laboratoire de Bactétiologie, Hôpital Pellegrin, Bordeaux, France
| | - Colm O'Morain
- Gastroenterology, Trinity College Dublin, Dublin, Ireland
| | - Javier P Gisbert
- Gastroenterolgy Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Madrid, Spain
| | | |
Collapse
|
13
|
Romstad KK, Detlie TE, Søberg T, Ricanek P, Jahnsen ME, Lerang F, Jahnsen J. Gastrointestinal bleeding due to peptic ulcers and erosions - a prospective observational study (BLUE study). Scand J Gastroenterol 2020; 55:1139-1145. [PMID: 32931710 DOI: 10.1080/00365521.2020.1819405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Acute upper gastrointestinal bleeding is a well-recognized complication of peptic ulcers and erosions. The aim of this study was to assess the incidence rate and identify risk factors for this complication in southeastern Norway. MATERIALS AND METHODS Between March 2015 and December 2017, a prospective observational study was conducted at two Norwegian hospitals with a total catchment area of approximately 800,000 inhabitants. Information regarding patient characteristics, comorbidities, drug use, H. pylori status and 30-day mortality was recorded. RESULTS A total of 543 adult patients were included. The incidence was 30/100,000 inhabitants per year. Altogether, 434 (80%) of the study patients used risk medication. Only 46 patients (8.5%) used proton pump inhibitors (PPIs) for more than 2 weeks before the bleeding episode. H. pylori testing was performed in 527 (97%) patients, of whom 195 (37%) were H. pylori-positive. The main comorbidity was cardiovascular disease. Gastric and duodenal ulcers were found in 183 (34%) and 275 (51%) patients, respectively. Simultaneous ulcerations at both locations were present in 58 (10%) patients, and 27 (5%) had only erosions. Overall, the 30-day mortality rate was 7.6%. CONCLUSIONS The incidence of upper gastrointestinal bleeding due to peptic ulcers and erosions was found to be lower than previously demonstrated in comparable studies, but the overall mortality rate was unchanged. The consumption of risk medication was high, and only a few patients had used prophylactic PPIs. Concurrent H. pylori infection was present in only one-third of the patients. CLINICAL TRIAL REGISTRATION Bleeding Ulcer and Erosions Study 'BLUE Study', ClinicalTrials.gov Identifier. NCT03367897.
Collapse
Affiliation(s)
- Katrine Kauczynska Romstad
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trond Espen Detlie
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Taran Søberg
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway
| | - Petr Ricanek
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Marte Eide Jahnsen
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Frode Lerang
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway
| | - Jørgen Jahnsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| |
Collapse
|
14
|
Nyssen OP, Pérez-Aisa Á, Tepes B, Rodrigo-Sáez L, Romero PM, Lucendo A, Castro-Fernández M, Phull P, Barrio J, Bujanda L, Ortuño J, Areia M, Brglez Jurecic N, Huguet JM, Alcaide N, Voynovan I, María Botargues Bote J, Modolell I, Pérez Lasala J, Ariño I, Jonaitis L, Dominguez-Cajal M, Buzas G, Lerang F, Perona M, Bordin D, Axon T, Gasbarrini A, Marcos Pinto R, Niv Y, Kupcinskas L, Tonkic A, Leja M, Rokkas T, Boyanova L, Shvets O, Venerito M, Bytzer P, Goldis A, Simsek I, Lamy V, Przytulski K, Kunovský L, Capelle L, Milosavljevic T, Caldas M, Garre A, Mégraud F, O'Morain C, Gisbert JP. Helicobacter pylori first-line and rescue treatments in patients allergic to penicillin: Experience from the European Registry on H pylori management (Hp-EuReg). Helicobacter 2020; 25:e12686. [PMID: 32173974 DOI: 10.1111/hel.12686] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Experience in Helicobacter pylori eradication treatment of patients allergic to penicillin is very scarce. A triple combination with a PPI, clarithromycin (C), and metronidazole (M) is often prescribed as the first option, although more recently the use of a quadruple therapy with PPI, bismuth (B), tetracycline (T), and M has been recommended. AIM To evaluate the efficacy and safety of first-line and rescue treatments in patients allergic to penicillin in the "European Registry of H pylori management" (Hp-EuReg). METHODS A systematic prospective registry of the clinical practice of European gastroenterologists (27 countries, 300 investigators) on the management of H pylori infection. An e-CRF was created on AEG-REDCap. Patients with penicillin allergy were analyzed until June 2019. RESULTS One-thousand eighty-four patients allergic to penicillin were analyzed. The most frequently prescribed first-line treatments were as follows: PPI + C + M (n = 285) and PPI + B + T + M (classic or Pylera® ; n = 250). In first line, the efficacy of PPI + C + M was 69%, while PPI + B + T + M reached 91% (P < .001). In second line, after the failure of PPI + C + M, two rescue options showed similar efficacy: PPI + B + T + M (78%) and PPI + C + levofloxacin (L) (71%) (P > .05). In third line, after the failure of PPI + C + M and PPI + C + L, PPI + B + T + M was successful in 75% of cases. CONCLUSION In patients allergic to penicillin, a triple combination with PPI + C + M should not be generally recommended as a first-line treatment, while a quadruple regimen with PPI + B + T + M seems to be a better option. As a rescue treatment, this quadruple regimen (if not previously prescribed) or a triple regimen with PPI + C + L could be used but achieved suboptimal (<80%) results.
Collapse
Affiliation(s)
- Olga P Nyssen
- Gastroenterology Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ángeles Pérez-Aisa
- Digestive Unit, Agencia Sanitaria Costa del Sol, Marbella, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Málaga, Spain
| | - Bojan Tepes
- Gastroenterology Unit, AM DC Rogaska, Rogaska Slatina, Slovenia
| | - Luis Rodrigo-Sáez
- Gastroenterology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | | | | | - Luis Bujanda
- Department of Gastroenterology, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), Donosti, Spain
| | - Juan Ortuño
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel Areia
- Portuguese Oncology Institute, Coimbra, Portugal
| | | | | | - Noelia Alcaide
- Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Irina Voynovan
- Department of Pancreatobiliary and Upper GI Diseases, Moscow Clinical Scientific Center, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | | | | | | | - Inés Ariño
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Laimas Jonaitis
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - György Buzas
- Gastroenterology Unit, Ferencváros Policlinic, Budapest, Hungary
| | - Frode Lerang
- Medical Department, Central Hospital Ostfold, Fredrikstad, Norway
| | | | - Dmitry Bordin
- Department of Pancreatobiliary and Upper GI Diseases, Moscow Clinical Scientific Center, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Toni Axon
- Gastroenterology Unit, University of Leeds, Leeds, UK
| | - Antonio Gasbarrini
- Gastronterology Area, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Ricardo Marcos Pinto
- Centro Hospitalar do Porto, Institute of Biomedical Sciences Abel Salazar, University of Porto and CINTESIS, University of Porto, Porto, Portugal
| | - Yaron Niv
- Department of Gastroenterology, Rabin Medical Center, Tel Aviv University, Petach Tikva, Israel
| | - Limas Kupcinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ante Tonkic
- Department of Gastroenterology, School of Medicine, University Hospital of Split, University of Split, Split, Croatia
| | - Marcis Leja
- Faculty of Medicine, Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
| | - Theodore Rokkas
- Gastroenterology Unit, Henry Dunant Hospital, Athens, Greece
| | - Lyudmila Boyanova
- Department of Medical Microbiology, Medical University of Sofia, Sofia, Bulgaria
| | - Oleg Shvets
- Internal Diseases Department No. 1, National Medical University named after O.O. Bogomolets, Kyiv, Ukraine
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - Peter Bytzer
- Department of Medicine, Zealand University Hospital, Copenhagen University, Copenhagen, Denmark
| | - Adrian Goldis
- Gastroenterology Unit, Timisoara Hospital, Timisoara, Romania
| | - Ilkay Simsek
- Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Vincent Lamy
- Department of Gastroenterology, Hepatology & Nutrition, CHU Charleroi, Charleroi, Belgium
| | - Krzysztof Przytulski
- Gastroenterology Unit, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - Lumír Kunovský
- Department of Gastroenterology and Internal Medicine and Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lisette Capelle
- Gastroenterology and Hepatology, Erasmus MC University, Rotterdam, The Netherlands
| | - Tomica Milosavljevic
- Medical Department, Clinical Center of Serbia Clinic for Gastroenterology and Hepatology, University of Belgrade, Belgrade, Serbia
| | - María Caldas
- Gastroenterology Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ana Garre
- Gastroenterology Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Francis Mégraud
- Laboratoire de Bactériologie, Hôpital Pellegrin, Bordeaux Cedex, France
| | - Colm O'Morain
- Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Javier P Gisbert
- Gastroenterology Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | | |
Collapse
|
15
|
Jelsness-Jørgensen LP, Lerang F, Sandvei P, Søberg T, Henriksen M. Magnetic endoscopic imaging during colonoscopy is associated with less pain and decreased need of analgesia and sedation--results from a randomized controlled trial. Scand J Gastroenterol 2013; 48:890-5. [PMID: 23721208 DOI: 10.3109/00365521.2013.800992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Colonoscopy is the method of choice for examining patients with lower gastrointestinal symptoms. The procedure is, however, in many cases, associated with pain and impaired compliance. Magnetic endoscopic imaging (MEI) generates a three-dimensional image of the colonoscope on a computer screen which may enable the colonoscopist to avoid looping, and consequently improve patient satisfaction. MATERIAL AND METHODS In this randomized controlled trial, 200 outpatients referred to colonoscopy at Østfold Hospital Trust, Fredrikstad, Norway, were included. Patients were randomized to either the standard arm (using fluoroscopy on demand, n = 100), or the MEI arm (n = 100). End points were time to cecum, subjective pain experiences, and use of sedation or analgesics. RESULTS Out of a total of 200 patients, 54% were men. However, no significant differences between the groups according to gender were found. Fluoroscopy was applied in 23% of the cases in the standard group. Use of MEI was associated with decreased time to cecum (p < 0.05), decreased pain scores (Visual Analogue Scale, p < 0.05), decreased need of analgesia (p < 0.01), and decreased amount of administered midazolam and pethidin (p < 0.05 in both). CONCLUSIONS MEI during colonoscopy was associated with decreased pain and less on-demand requests for sedation and analgesia. In addition, the use of MEI reduced the cecal intubation time. Consequently the implementation of magnetic endoscopic imaging in the endoscopy suits may be beneficial, particularly in the clinically difficult cases.
Collapse
|
16
|
|
17
|
de Boer WA, Lerang F. Serology for follow-up ofHelicobactertherapy. Eur J Gen Pract 2009. [DOI: 10.3109/13814789909094290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
18
|
Henriksen TH, Lerang F, Lia A, Schøyen R, Thoresen T, Berge T, Ragnhildstveit E, Tveten Y, Berstad A. Laboratory handling of Helicobacter pylori critically influences the results of in-vitro metronidazole resistance determination. Clin Microbiol Infect 2004; 10:315-21. [PMID: 15059120 DOI: 10.1111/j.1198-743x.2004.00779.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In-vitro metronidazole resistance rates of Helicobacter pylori determined by Etest are high, and the predictive value of metronidazole resistance is low. It was hypothesised that altered laboratory methods could reduce the overestimation of resistance and improve the predictive value of the Etest. Pre-treatment isolates (n = 150) of H. pylori from 150 patients were investigated by Etest with incubation for 72 h. Treatment with metronidazole, tetracycline and bismuth for 10 days failed to eradicate H. pylori in 23 patients. After isolate storage for 3 years, resistance determination results by agar dilution and Etest, with incubation for 72 and 31 h, were compared. The rate of metronidazole resistance was reduced significantly during storage, and instability of resistance was associated significantly with treatment outcome. Isolates that retained in-vitro resistance had significantly (p 0.008) higher treatment failure rates (n = 13; 42%) than isolates that lost resistance (n = 3; 9%). The reproducibility achieved by dual testing with agar dilution and Etest was 41% and 70% for +/- 1 and +/- 2 log2 dilutions, respectively, after incubation for 72 h, and 85% and 92%, respectively, after incubation for 31 h. Thus, the predictive value was improved from 25% to 50% by the altered laboratory conditions (p 0.04). MIC values of 2-8 mg/L signified an intermediate risk of treatment failure.
Collapse
Affiliation(s)
- T H Henriksen
- Department of Microbiology, Sentralsykehuset i Vestfold, Tønsberg, Norway.
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Moum B, Hauge T, Lerang F, Sandvei P, Henriksen M, Pettersen T. [Assessment of the need of 24-hour availability of endoscopy]. Tidsskr Nor Laegeforen 2001; 121:3396-8. [PMID: 11826784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Endoscopy is the cornerstone of the diagnosis and treatment of acute conditions in the upper part of the gastrointestinal tract. The need for 24-hour availability of gastroscopy for these conditions has not previously been assessed. MATERIAL AND METHODS We assessed the need for emergency gastroscopy in cases of acute upper gastrointestinal bleeding and obstruction by foreign bodies. The assessment was made by a gastroenterologist before gastroscopy was performed, and was based on the available clinical data for the period lasting from admission to hospital to the time of examination. RESULTS A total of 162 patients were referred and examined. About half of them arrived at the hospital outside working hours. Of these, 47% were assessed as being in need of emergency gastroscopy. We therefore found that emergency gastroscopy outside working hours was needed twice a month per 100,000 people. INTERPRETATION Round-the-clock endoscopy should be available at acute-care hospitals in the same way as other emergency help.
Collapse
Affiliation(s)
- B Moum
- Medisinsk avdeling, Sykehuset Østfold Fredrikstad 1603 Fredrikstad.
| | | | | | | | | | | |
Collapse
|
20
|
Hauge T, Moum B, Sandvei P, Lerang F, Ravneng P. [Argon plasma coagulation--a new method in therapeutic endoscopy]. Tidsskr Nor Laegeforen 2000; 120:1413-5. [PMID: 10851937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND By argon plasma coagulation (APC), a current is applied to tissues as ionised gas. Special probes have recently been developed for applying the gas through flexible endoscopes. In the field of therapeutic endoscopy, this method is promising for several diseases in the gastrointestinal tract. MATERIAL AND METHODS At Ostfold Hospital in Fredrikstad, Norway, 122 treatments in 80 patients were performed during the years 1997-99. RESULTS The new method was useful for endoscopic treatment of haemorrhages, tumour debulking and tumour ingrowth and overgrowth in oesophageal stents. Abdominal pain was related to insufflation of air and gas. Complications related to the method were not observed. INTERPRETATION Our experience with this new method was very positive. The method was effective, had a very low complication rate, and the equipment was easy to use. The application of APC in premalignant conditions is discussed.
Collapse
Affiliation(s)
- T Hauge
- Gastroseksjonen Medisinsk avdeling, Sykehuset Ostfold Fredrikstad
| | | | | | | | | |
Collapse
|
21
|
Lygren I, Andersen LP, Lerang F, Kleveland PM, Farup P, Vatn M, Aursnes I. [Treatment of Helicobacter pylori infection]. Tidsskr Nor Laegeforen 1998; 118:4511-4. [PMID: 9889634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
The article presents information gained from a survey among Norwegian hospitals in March 1997 concerning their treatment of infections with Helicobacter pylori. Altogether 52 hospitals answered the questionnaire. A combination of proton pump inhibitors, metronidazole and clarithromycin was used by 59% as first choice and urea quick test (94%) and urea breath test (42%) as the primary diagnostic procedures, whereas serology was in little use (17%). Besides ordinary ulcer disease, indications for treatment were: ulcer induced by non-steroid anti-inflammatory drugs (79%), gastrooesophageal reflux (37%), non-ulcer dyspepsia (14%) and cancer prophylaxis (14%). The gastro group at the Department of Pharmacotherapeutics at the University of Oslo invited specialists from all health regions to discuss indications for treatment of H pylori, the diagnosis and the role of general practitioners. The extensive use of clarithromycin might be doubtful due to development of resistance. Indications for treatment of H pylori other than ulcer disease and mucosa associated lymphoid tissue lymphoma are still uncertain. Uncritical use of serological tests in primary care should be discouraged. At present there is no uniform strategy for the diagnosis and treatment of H pylori infection, and a coordinated strategy between general practitioners and specialists is needed.
Collapse
Affiliation(s)
- I Lygren
- Medisinsk avdeling, Ullevål sykehus, Oslo
| | | | | | | | | | | | | |
Collapse
|
22
|
Lerang F, Haug JB, Moum B, Mowinckel P, Berge T, Ragnhildstveit E, Bjørneklett A. Accuracy of IgG serology and other tests in confirming Helicobacter pylori eradication. Scand J Gastroenterol 1998; 33:710-5. [PMID: 9712234 DOI: 10.1080/00365529850171648] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND In this study we assessed the accuracy of IgG serology and other tests in confirming Helicobacter pylori eradication. METHODS The outcome of anti-H. pylori therapy was established by at least two of the following tests: rapid urease test (RUT), culture, 14C urea breath test (non-capsule or capsule UBT), and IgG serology (Orion Diagnostica Pyloriset New EIA-G). RESULTS Successful H. pylori eradication was confirmed in 698 of 794 patients (88%). The percentage decrease in IgG antibody titre was related to the patients' pre-treatment IgG titre and time interval after treatment. A decrease in IgG titres of 40% or more confirmed H. pylori eradication with 100% specificity, whereas the sensitivity was 82%, 90%, 98%, and 98% 3, 4, 5, and 6 months after therapy, respectively. The 40% cut-off confirmed eradication 3 to 6 months after therapy in 328 of 339 patients (97%) with pre-treatment IgG titres of >700, in 36 of 45 patients (80%) with pre-treatment titres of 300-700, and in 5 of 12 patients (42%) with pretreatment titres of <300. The sensitivity and specificity of the other tests 2 months after treatment were as follows: RUT, 84% and 100%; culture, 88% and 100%; non-capsule UBT, 100% and 89%; and capsule UBT, 100% and 97%. CONCLUSION A decrease in IgG antibody titre of 40% or more 3 to 6 months after therapy and the capsule 14C UBT at the 2-month follow-up were both highly accurate in confirming H. pylori eradication.
Collapse
Affiliation(s)
- F Lerang
- Dept. of Internal Medicine, Ostfold Central Hospital, Fredrikstad, Norway
| | | | | | | | | | | | | |
Collapse
|
23
|
Lerang F, Moum B, Mowinckel P, Haug JB, Ragnhildstveit E, Berge T, Bjørneklett A. Accuracy of seven different tests for the diagnosis of Helicobacter pylori infection and the impact of H2-receptor antagonists on test results. Scand J Gastroenterol 1998; 33:364-9. [PMID: 9605257 DOI: 10.1080/00365529850170982] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In this study we compared the accuracy of seven diagnostic tests in diagnosing Helicobacter pylori infection. METHODS Over 1 year 351 consecutive dyspeptic patients were tested for H. pylori infection by means of antral biopsy specimens for the rapid urease test (RUT), culture, microscopy (acridine stain), and the laboratory urease test (LUT) and, in addition, with 14C urea breath test (UBT), IgG serology, and IgA serology (Orion Diagnostica Pyloriset New EIA-G and New EIA-A). The criterion for H. pylori infection was a minimum of three positive tests. Before being tested, 38% of the patients had used an H2-receptor antagonist (H2RA). RESULTS Two-hundred and twenty-four patients (64%) were H. pylori-positive. The sensitivity and specificity of the tests were as follows (percentages): RUT, 85, 99; culture, 93, 100; microscopy, 81, 98; LUT, 80, 100; UBT, 95, 95; IgG serology, 99, 91; and IgA serology, 88, 91. The accuracy of the RUT and LUT was reduced in patients receiving H2RA therapy (P=0.04 and 0.01, respectively). CONCLUSIONS Culture, UBT, and IgG serology were all superior to the other four tests in diagnosing H. pylori infection. Invasive urease-based tests were less accurate in patients receiving H2RAs.
Collapse
Affiliation(s)
- F Lerang
- Dept. of Internal Medicine, Ostfold Central Hospital, Fredrikstad, Norway
| | | | | | | | | | | | | |
Collapse
|
24
|
Lerang F, Moum B, Ragnhildstveit E, Sandvei PK, Tolås P, Whist JE, Henriksen M, Haug JB, Berge T. Simplified 10-day bismuth triple therapy for cure of Helicobacter pylori infection: experience from clinical practice in a population with a high frequency of metronidazole resistance. Am J Gastroenterol 1998; 93:212-6. [PMID: 9468244 DOI: 10.1111/j.1572-0241.1998.00212.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the cure rate of Helicobacter pylori infection, including the impact of in vitro metronidazole resistance (M-R), and the side effects of a simplified 10-day bismuth triple therapy in routine clinical practice. METHODS From September 1995 to March 1996, 248 consecutive H. pylori-positive patients received 10 days of bismuth subnitrate 150 mg, oxytetracycline 500 mg, and metronidazole 400 mg, all t.id. Before treatment, upper endoscopy, including biopsy specimens for microbiological analysis and IgG serology were performed. M-R was found in 45% of females and 36% of males. At least 2 months after treatment, H. pylori status was assessed by the 14C urea breath test (n = 131), endoscopy (n = 37), urea breath test and endoscopy (n = 63), or solely by IgG serology (n = 7). Ten patients withdrew. IgG serology was performed again after 1 yr. RESULTS H. pylori infection was cured in 205 patients: 86% by all-patients-treated analysis and 83% by intention-to-treat analysis. When patients were classified according to pretreatment metronidazole susceptibility, cure of infection was achieved in 76% of females harboring M-R strains versus 96% of those with sensitive strains (p = 0.002) and in 81% versus 88% (p = 0.34) of males with M-R versus sensitive strains, respectively. Twelve patients (5 %) had to stop treatment prematurely because of severe side effects, but eight of them were treated successfully. One case of H. pylori infection (0.6 %) was detected at 1-yr follow-up. CONCLUSIONS Ten-day bismuth triple therapy t.i.d. was effective in curing H. pylori infection in the context of routine clinical practice. The efficacy was reduced in females harboring M-R strains.
Collapse
Affiliation(s)
- F Lerang
- Department of Internal Medicine, Ostfold Central Hospital, Fredrikstad, Norway
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Lerang F, Moum B, Haug JB, Berge T, Tolås P, Sandvei PK, Torp R, Tønnesen T. Highly effective second-line anti-Helicobacter pylori therapy in patients with previously failed metronidazole-based therapy. Scand J Gastroenterol 1997; 32:1209-14. [PMID: 9438318 DOI: 10.3109/00365529709028149] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND In this study we compared the cure rates of two clarithromycin-based regimens in patients in whom anti-Helicobacter pylori therapy had previously failed. METHODS Thirty-three patients were randomized to receive either regimen OAC (20 mg omeprazole, 750 mg amoxicillin, and 250 mg clarithromycin) or BTC (240 mg bismuth subcitrate, 750 mg oxytetracycline, and 250 mg clarithromycin), all twice daily for 10 days. A further 28 patients were all treated with OAC. Previously failed therapy included combinations of bismuth (B), omeprazole (O), tetracycline (T), metronidazole (M), amoxicillin (A), or clarithromycin (C) in BTM (n = 48), OAM (n = 13), OA (n = 7), OCM (n = 2), or BCM (n = 1). H. pylori infection was confirmed by culture of biopsy specimens, and antimicrobial susceptibility testing was performed with the E test. RESULTS H. pylori infection was cured in all patients (n = 18) with OAC and in 8 patients (53%) with BTC (P = 0.001) in the randomized group and in 27 patients (96%) receiving OAC in the open-label group. CONCLUSIONS Ten-day OAC is highly effective and superior to BTC in patients in whom metronidazole-based treatment has previously failed.
Collapse
Affiliation(s)
- F Lerang
- Dept. of Internal Medicine, Ostfold Central Hospital, Fredrikstad, Norway
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Lerang F, Moum B, Ragnhildstveit E, Haug JB, Hauge T, Tolås P, Aubert E, Henriksen M, Efskind PS, Nicolaysen K, Søberg T, Odegaard A, Berge T. A comparison between omeprazole-based triple therapy and bismuth-based triple therapy for the treatment of Helicobacter pylori infection: a prospective randomized 1-yr follow-up study. Am J Gastroenterol 1997; 92:653-8. [PMID: 9128317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To compare the efficacy and side effects of standard bismuth triple therapy with those of omeprazole-based triple therapy in patients with Helicobacter pylori infection and duodenal ulcer disease. METHODS One hundred patients were prospectively recruited and randomized to receive either bismuth subnitrate 75 mg q.i.d., oxytetracycline 500 mg q.i.d., and metronidazole 400 mg b.i.d. (regimen BTM), or omeprazole 20 mg b.i.d., amoxicillin 750 mg b.i.d., and metronidazole 400 mg b.i.d. (regimen OAM), both for 14 days. Upper endoscopy (with antral biopsy specimens for microbiology and antral and corpus biopsy specimens for histology) was performed before treatment, after 2 months, and again 1 yr after treatment. Serum samples for serology (IgG) were taken. Patients with in vitro metronidazole-resistant (M-R) H. pylori strains were excluded. In a nonrandomized study, 41 patients with M-R strains were given either BTM or OAM. RESULTS According to intention-to-treat analysis, H. pylori cure rates were 91% and 96% with BTM and OAM, respectively (p = 0.45). In the BTM group, the mean total side effect score was higher (p < 0.001), and more severe side effects were reported (32% vs. 4%, p < 0.001). In the nonrandomized group of patients with M-R strains, H. pylori cure rates were 88% and 67% with BTM and OAM, respectively. All of the successfully treated patients were still H. pylori-negative after 1 yr. CONCLUSIONS Both treatment regimens were highly effective in curing H. pylori infection in patients with metronidazole-sensitive strains. Omeprazole-based triple therapy was tolerated better than standard bismuth-based triple therapy.
Collapse
Affiliation(s)
- F Lerang
- Department of Internal Medicine, Ostfold Central Hospital, Fredrikstad, Norway
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Lerang F, Moum B, Haug JB, Tolås P, Breder O, Aubert E, Høie O, Søberg T, Flaaten B, Farup P, Berge T. Highly effective twice-daily triple therapies for Helicobacter pylori infection and peptic ulcer disease: does in vitro metronidazole resistance have any clinical relevance? Am J Gastroenterol 1997; 92:248-53. [PMID: 9040200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To compare cure rates of Helicobacter pylori (H. pylori) infection, ulcer healing, and side effects of three simplified regimens of triple therapy in patients with peptic ulcer disease. METHODS Two hundred thirty-one patients were prospectively randomized to receive either regimen OAM (omeprazole 20 mg b.i.d., amoxicillin 750 mg b.i.d., and metronidazole 400 g b.i.d.), OCM (omeprazole 20 mg b.i.d., clarithromycin 250 mg b.i.d., and metronidazole 400 mg b.i.d.), or BCM (bismuth subcitrate 240 mg b.i.d., clarithromycin 250 mg b.i.d., and metronidazole 400 mg b.i.d.), all for 10 days. Side effects were reported immediately afterward in a self-administered questionnaire. Upper endoscopy was carried out before treatment and 2 months after treatment. Three antral and three corpus biopsy specimens were analyzed microbiologically and with rapid urease test to determine the presence of H. pylori. Altogether 143 patients (62%) had an active ulcer at start of treatment. Metronidazole resistant (M-R) H. pylori strains were found in 30% of patients, while none had clarithromycin resistant (C-R) strains. RESULTS According to intention-to-treat analysis, H. pylori cure rates were 91, 95, and 95% with OAM, OCM, and BCM, respectively (p = 0.63). In patients with metronidazole-sensitive (M-S) strains versus M-R strains, the cure rates were 96 versus 77% with OAM (p = 0.025), 94 versus 94% with OCM, and 94 versus 96% with BCM. Ulcer healing rates were 95, 94, and 92%, respectively (p = 0.91). There were no significant differences in side effects between the regimens, and only five patients (2%) had to stop the treatment prematurely. CONCLUSIONS All treatment regimens were highly effective for cure of H. pylori infection and for ulcer healing. Metronidazole resistance reduced the efficacy of OAM, but was of no importance for the efficacy of OCM or BCM. Side effects were of minor importance.
Collapse
Affiliation(s)
- F Lerang
- Department of Internal Medicine, Ostfold Central Hospital, Fredrikstad, Norway
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Lerang F, Moum B, Ragnhildstveit E. [Alternative treatment of Helicobacter pylori infections]. Tidsskr Nor Laegeforen 1994; 114:1465. [PMID: 8079238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
|
29
|
Gran JT, Lerang F, Laegreid IK, Hansen J, Husby G, Hordvik M. [Epidemiologic aspects of Bechterew's disease]. Tidsskr Nor Laegeforen 1986; 106:1677-9, 1676. [PMID: 3775697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
|