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

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.

[Accuracy of lactase gene C/T-13910 polymorphism and hydrogen breath test in a gastroenterology outpatient clinic: a retrospective study]

INTRODUCTION

Adult type hypolactasia is the most prevalent carbohydrate malabsorption.

AIM

To assess the distribution of lactase gene C/T-13910 polymorphism and the accuracy and concordance of a genetic test and H(2) breath test in the diagnosis of adult type hypolactasia.

METHOD

496 patients with symptoms of lactose intolerance were enrolled in a retrospective study who underwent genetic test using TaqMan polymerase chain reaction and H(2) breath test.

RESULTS

The prevalence of C/T-13910 genotypes was: CC 48.1%, TC: 40.5%, and TT: 11.4%. When the genetic test was taken as reference, the sensitivity of the breath test was 84.3%, with a specificity of 95.7%, a positive predictive value of 96.7% and negative predictive value of 80.4%. Conversely, the accuracy of genetic test was: sensitivity 96.6%, specificity 80.4%, positive predictive value 84.3% and negative predictive value 95.7%. The concordance value between the two tests (kappa index) was 0.78. The results were discordant in 11.1% of the cases.

CONCLUSIONS

In symptomatic patients, the lactase non-persistence genotype CC occurred in almost half of the patients. Both the genetic and the breath tests are sufficiently accurate, with good predictive value and they can be used to set up the diagnosis. Discordant results should be carefully interpreted.

[The role of Orvosi Hetilap in the development of Hungarian gastroenterology. Part 1: 1857-1904]

The role of the Hungarian weekly medical journal Orvosi Hetilap - first published in 1857 - in the development of special medical fields has not been studied.

AIM

Analysis of the papers dealing with diseases of the gastrointestinal tract published in Orvosi Hetilap.

METHOD

The author manually reviewed the journal volumes between 1857 and 1904. The original articles, journal and book reviews were identified and classified according to their subject and origin.

RESULTS

In the period studied, 455 original articles were published about gastrointestinal diseases, constituting 8.2% of the total publications. Diseases of the oesophagus were studied in 2.4% of the articles, gastric disturbances in 14.7%, intestinal diseases in 14.2%, and hepatobiliary diseases in 24.2%. 592 journal articles were reviewed from 113 different publications, 52.5% being German, 15.9% French and 10.0% English; 42.7% of the articles were published in 10 core journals (8 German and 2 British). Many of the 116 books presented became classics of the medical literature. Basic knowledge in endoscopy was mediated by French and German authors. After pioneering laryngoscopic and urologic examinations, the first oesophagoscopies with rigid instruments were performed in 1902. The most studied field was hepatology: the clinical and pathologic features of acute liver failure, chronic hepatitis and cirrhosis were then described.

CONCLUSIONS

Most of the contemporary aspects of gastrointestinal diseases were covered by the original articles published in Orvosi Hetilap . German and French and, to a lesser extent, British sources of scientific information prevailed. Diseases of the liver and biliary tract were studied in most detail.

Colonic sensitivity in irritable bowel syndrome and normal subjects according to their hemispheric preference and cognitive style

According to our earlier results, non-painful, weak afferent visceral signals may exert a steady influence on brain processes, including cognitive functions. In the present series colonic impulses of irritable bowel syndrome (IBS) subjects served as a model of chronic impact from the gut. Hemispheric preference, as well as cognitive style of information processing served as indicators of covert changes in brain functions. In twenty-one IBS patients and in ten control subjects of both sexes, the thresholds of minimal colonic distension sensitivity has been measured following the determination of hemispheric preference and of advantage in verbal or spatial information processing of the subjects. In IBS patients distension thresholds proved to be higher in verbals than in spatials, whereas in healthy controls the relationship of colonic thresholds and verbal versus spatial advantage was reversed. Among the normal controls with left hemisphere preference a significantly higher distension threshold has been observed than in those with right hemisphere preference, whereas in the IBS group such threshold-differences were not observable.

Prevention of indomethacin-induced acute gastric mucosal injury by spermine in the rat

The effect of spermine tetrahydrochloride was investigated on the indomethacin-induced acute mucosal injury and mucosal lipid peroxidation in rats. Spermine was given orally at doses of 25, 75 and 150 mg/kg and, intraperitoneally at 10, 25 and 50 mg/kg 1 hour before 25 mg/kg indomethacin administration. Macroscopic injury was measured by the use of a stereomicroscope. Mucosal malondialdehyde (MDA) levels were determined by an HPLC method. Oral spermine reduced dose-dependently the extent of macroscopic injury from 22.87 +/- 2.88 mm to 11.8 +/- 2.48 mm (p < 0.01, 25 mg/kg), 6.53 +/- 4.19 mm (p < 0.0007, 75 mg/kg) and 0.25 +/- 0.25 mm (p < 0.0001,150 mg/kg). Intraperitoneally administered spermine prevented dose-dependently the indomethacin produced lesions from 19.25 +/- 4.31 mm to 12.63 +/- 3.18 mm (p < 0.01, 25 mg/kg) and to 0.33 +/- 0.33 mm (p < 0.001, 50 mg/kg). Doses necessary for intraperitoneal protection were lower than those achieving similar effect, orally suggesting different mechanisms of action. Neither oral or intraperitoneal spermine influenced the mucosal MDA levels.

[Growth factors in experimental ulcer]

Important role is attributed to the growth factors in the development, growth, and restitution after injury of the gastrointestinal tract. The common feature of growth factors is their ability to stimulate the growth and mitosis of quiescent cells in a nutritionally complete medium which in itself is not sufficient to initiate cell division. Epidermal growth factor prevents efficiently the experimentally induced acute gastric mucosal lesions induced by aspirin, absolute ethanol, HCl, NaCl, immobilization, and immersion and it accelerates the healing of acetic acid-induced chronic gastric and cysteamine-induced chronic duodenal ulcers. It proved to be also useful in the treatment of human gastric ulcers. Fibroblast growth factor possesses similar gastroprotective and chronic ulcer-healing properties. Its effects is much more potent than that of epidermal growth factor and that of H2-receptor blockers. The "trefoil"-peptides constitute the latest family of growth factors which are supposed to be involved in the regeneration of the normal and the ulcerated gastrointestinal mucosa. Polyamines are non-peptide growth promoting compounds present in all eukaryotic cells; their gastroprotective and ulcer-healing properties have also been published. The use of some growth factors as regenerative and angiogenic therapy could open a new, alternative way in the future management of peptic ulcer disease.