European Registry on the management of Helicobacter pylori infection (Hp-EuReg): analysis of 2360 patients receiving first-line therapy in Russia

AIM

European Registry on the management of Helicobacter pylori infection («Hp-EuReg») - a multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group, conducted in 27 European countries in order to evaluate the real clinical practice of diagnosis and treatment of H. pylori and its comparison with international recommendations.

MATERIALS AND METHODS

The analysis of 2360 patients entered in the register by the Russian centres of «Hp-EuReg» in 2013-2017, who were underwent 1st line eradication therapy.

RESULTS

The most common methods of primary diagnosis of H. pylori are histological (37.7%), rapid urease test (29.2%) and serology (29.7%). The duration of eradication therapy in 9.4% of cases was 7 days, in 65.3% - 10 days, and in 25.3% - 14 days. To control the effec- tiveness of treatment, H. pylori antigen in feces (31.3%), urea breath test (23.4%) and histological method (23.3%) were used. In 3.6% cases was used serology by mistake. In 17.3% of patients control was not carried out. The effectiveness of triple therapy with a PPI, amoxicillin, clar- ithromycin (per protocol) was 67.6%, with 7-day course, 81.1% at 10-day and 86.7% at 14-day course. Eradication rate of triple therapy with addition of bismuth (per protocol) reached 90,6% in the group receiving 10-day scheme and 93.6% in the group receiving the 14-day treatment.

CONCLUSION

Significant deviations of clinical practice from expert recommendations, most pronounced at the stage of monitoring the effectiveness of therapy, were noted. The suboptimal efficacy of triple therapy is shown.

[European registry Helicobacter pylori (Hp-EuReg): how has clinical practice changed in Russia from 2013 to 2018 years]

The multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group (EHMSG) is conducted in 27 countries in Europe. The data from the Russian part of the European registry for the management of Helicobacter pylori infection (European Registry on the management of Helicobacter pylori infection, protocol: "Hp-EuReg") allows us to analyze the real clinical practice of diagnosis and treatment of H. pylori and compare it with international recommendations.

MATERIALS AND METHODS

A comparative analysis of the data entered in the register by the Russian research centers "Hp-EuReg", in the period from 2013 to 2018, was conducted.

RESULTS AND DISCUSSION

Invasive diagnostic methods prevail for the primary diagnosis of H. pylori [histology - 20.3% (in 2013 year) - 43.9% (in 2018 year), rapid urease test - 31.7% and 47.8% respectively]. The most popular mode of eradication therapy is a 10-day triple therapy (62.8-76.2%), the effectiveness of which does not exceed 79% (per protocol). Invasive tests (histology) are the leading method for control the effectiveness of therapy, however, there is a tendency towards a wider use of non-invasive methods (H. pylori stool antigen - from 17% in 2013 to 29.3% in 2018 and urea breath test from 6.9 to 18.3%, respectively). Serological test to control the effectiveness of eradication is still used from 8.2% (2013) to 6.1% (2018). Eradication therapy was not performed in 28% of patients throughout the entire observation period.

CONCLUSION

In Russia, despite approved domestic and international recommendations, deviations in clinical practice persist, both during eradication therapy and in monitoring the effectiveness of eradication therapy.

[Helicobacter pylori: what schemes of eradication are essential today?]

Current approaches to treatment of Helicobacter pylori infection, basic international recommendations, problems of growing H. pylori resistance to antibiotics are reviewed. Much attention is given to prospects of new eradication schemes, for example combinations based on bismuth tripotassium dicitrate and successive treatment schedules.

[The quality of life dynamics in patients with gastroesophageal reflux disease during rabeprazol therapy]

The present article represents findings of quality of life index dynamics for 100 patients with gastroesophageal reflux disease under pressure of proton pump inhibitor therapy. The degree of clinical evidence was measured by Likert scale, quality of life appraisal was made on the bases of SF-36, GSRS checklists, psychoemotional component of patients' health was analyzed with the help of the V.M. Bekhterev Institute personal enquirer. Treatment with Rabeprazole helps efficiently jugulate reflux disease symptoms and accurately improve quality of life index.

[Problems and prospects of non-invasive screening for colorectal cancer]

High prevalence of colorectal cancer makes it a most serious socio-medical problem. Hence, the necessity of overall screening for prodromal changes and malignant neoplasms at the early stages of the disease. Despite a variety of efficacious instrumental diagnostic tools, the development of non-invasive screening techniques based on recent progress in understanding molecular mechanisms of carcinogenesis remains a highly topical issue. A pathogenetic model of colorectal cancer and pathophysiological basis of screening for colonic neoplasms are considered with the emphasis on the detection of tumour cells in faeces and their DNA carrying mutations in suppressor genes and oncogenes. Results of the studies with the use of one or several DNA oncomarkers are analysed in the context of their value for the diagnosis of colorectal neoplasms. High sensitivity and specificity of these methods make them very promising for application to the screening for colorectal cancer.

[Combined therapy of acid-dependent gastrointestinal disorders with the use of antacidic drug Relcer]

The aim of the study was to evaluate clinical efficiency of antacidic drug Relcer included in combined therapy of gastroesophagal reflux disease (GERD) and ulcer disease (UD). Group 1 comprised 47 patients with GERD and group 2 49 patients with gastric and duodenal UD. Each group was divided into study (A) and control (B) subgroups. All GERD patients were given rabeprazole and metoclopramide, patients with UD received rebaprazole, clarithromycin and amoxicillin. Relcer was additionally prescribed to 24 patients in group 1A and 26 in 2A. Duration of therapy in all groups was 14 days. By the end of the study, all symptoms of GERD were eliminated in 100% of the patients in group 1A and in 78.3% in 1B. Pain and heartburn in group 1A were reduced or eliminated within 5 and 7.8 min respectively after the first dose of Relcer. The same complaints in 69.9% of 1B patients were resolved by the end of the first day. The remaining ones benefited from combined treatment on day 2 Rapid and complete elimination of UD symptoms was finally achieved in 21.7-26.1% of 2A patients whereas moderate dyspeptic syndrome persisted in those of subgroup 2B. Ulcer scarring completed by day 14 in 88.5 and 87% of the patients in subgroups 2A and 2B respectively. Eradication of H. pylori was achieved in 92.3 and 87% of the patients in these groups. It is concluded that introduction of Relcer into combined therapy of GERD and UD improves its results and accelerates elimination of clinical symptoms.

[Bismuth preparations in the treatment of patients with gastric and duodenal ulcer disease]

Studies of the role of H. pylori (Hp) in etiopathogenesis of a number of common diseases of the upper gastrointestinal tract changed traditional approaches to their management with emphasis on antibiotic therapy. Positive effect of Hp eradication was confirmed in numerous randomized clinical studies. Bismuth-containing drugs have been used for a long time to treat gastrointestinal disorders. To-day, bismuth tri-potassium di-citrate (de---nol) is considered to be an optimal tool for different schemes of eradication therapy (triple and quadruple therapy of the first and second lines) and recommended to improve its efficiency by overcoming resistance of Hp to antibiotics. The overall efficacy of anti-helicobacterial therapy using bismuth tri-potassium di-citrate amounts to 81-98%. This compound has cytoprotective effect on gastric and duodenal mucosa, besides antibacterial action. All these properties characterize de-nol as a single universal preparation for the treatment of erosive ulcers in the gastrointestinal tract.