Background: Management of Helicobacter pylori (H. pylori) infection requires co-treatment with proton pump inhibitors (PPIs) and the use of antibiotics to achieve successful eradication. Aim: To evaluate the role of dosage of PPIs and the duration of therapy in the effectiveness of H. pylori eradication treatments based on the ‘European Registry on Helicobacter pylori management’ (Hp-EuReg). Methods: Hp-EuReg is a multicentre, prospective, non-interventionist, international registry on the routine clinical practice of H. pylori management by European gastroenterologists. All infected adult patients were systematically registered from 2013 to 2022. Results: Overall, 36,579 patients from five countries with more than 1000 patients were analysed. Optimal (≥90%) first-line-modified intention-to-treat effectiveness was achieved with the following treatments: (1) 14-day therapies with clarithromycin-amoxicillin-bismuth and metronidazole-tetracycline-bismuth, both independently of the PPI dose prescribed; (2) All 10-day (except 10-day standard triple therapy) and 14-day therapies with high-dose PPIs; and (3) 10-day quadruple therapies with clarithromycin-amoxicillin-bismuth, metronidazole-tetracycline-bismuth, and clarithromycin-amoxicillin-metronidazole (sequential), all with standard-dose PPIs. In first-line treatment, optimal effectiveness was obtained with high-dose PPIs in all 14-day treatments, in 10- and 14-day bismuth quadruple therapies and in 10-day sequential with standard-dose PPIs. Optimal second-line effectiveness was achieved with (1) metronidazole-tetracycline-bismuth quadruple therapy for 14- and 10 days with standard and high-dose PPIs, respectively; and (2) levofloxacin-amoxicillin triple therapy for 14 days with high-dose PPIs. None of the 7-day therapies in both treatment lines achieved optimal effectiveness. Conclusions: We recommend, in first-line treatment, the use of high-dose PPIs in 14-day triple therapy and in 10-or 14-day quadruple concomitant therapy in first-line treatment, while standard-dose PPIs would be sufficient in 10-day bismuth quadruple therapies. On the other hand, in second-line treatment, high-dose PPIs would be more beneficial in 14-day triple therapy with levofloxacin and amoxicillin or in 10-day bismuth quadruple therapy either as a three-in-one single capsule or in the traditional scheme.

Role of proton pump inhibitors dosage and duration in Helicobacter pylori eradication treatment: Results from the European Registry on H. pylori management / Pabon-Carrasco M.; Keco-Huerga A.; Castro-Fernandez M.; Saracino I.M.; Fiorini G.; Vaira D.; Perez-Aisa A.; Tepes B.; Jonaitis L.; Voynovan I.; Lucendo A.J.; Lanas A.; Martinez-Dominguez S.J.; Almajano E.A.; Rodrigo L.; Vologzanina L.; Brglez Jurecic N.; Denkovski M.; Bujanda L.; Abdulkhakov R.A.; Huguet J.M.; Fernandez-Salazar L.; Alcaide N.; Velayos B.; Silkanovna Sarsenbaeva A.; Zaytsev O.; Ilchishina T.; Barrio J.; Bakulin I.; Perona M.; Alekseenko S.; Romano M.; Gravina A.G.; Nunez O.; Gomez Rodriguez B.J.; Ledro-Cano D.; Pellicano R.; Bogomolov P.; Dominguez-Cajal M.; Almela P.; Gomez-Camarero J.; Bordin D.S.; Gasbarrini A.; Kupcinskas J.; Cano-Catala A.; Moreira L.; Nyssen O.P.; Megraud F.; O'Morain C.; Gisbert J.P.. - In: UNITED EUROPEAN GASTROENTEROLOGY JOURNAL. - ISSN 2050-6406. - ELETTRONICO. - 12:1(2023), pp. 122-138. [10.1002/ueg2.12476]

Role of proton pump inhibitors dosage and duration in Helicobacter pylori eradication treatment: Results from the European Registry on H. pylori management

Saracino I. M.;Fiorini G.;Vaira D.;
2023

Abstract

Background: Management of Helicobacter pylori (H. pylori) infection requires co-treatment with proton pump inhibitors (PPIs) and the use of antibiotics to achieve successful eradication. Aim: To evaluate the role of dosage of PPIs and the duration of therapy in the effectiveness of H. pylori eradication treatments based on the ‘European Registry on Helicobacter pylori management’ (Hp-EuReg). Methods: Hp-EuReg is a multicentre, prospective, non-interventionist, international registry on the routine clinical practice of H. pylori management by European gastroenterologists. All infected adult patients were systematically registered from 2013 to 2022. Results: Overall, 36,579 patients from five countries with more than 1000 patients were analysed. Optimal (≥90%) first-line-modified intention-to-treat effectiveness was achieved with the following treatments: (1) 14-day therapies with clarithromycin-amoxicillin-bismuth and metronidazole-tetracycline-bismuth, both independently of the PPI dose prescribed; (2) All 10-day (except 10-day standard triple therapy) and 14-day therapies with high-dose PPIs; and (3) 10-day quadruple therapies with clarithromycin-amoxicillin-bismuth, metronidazole-tetracycline-bismuth, and clarithromycin-amoxicillin-metronidazole (sequential), all with standard-dose PPIs. In first-line treatment, optimal effectiveness was obtained with high-dose PPIs in all 14-day treatments, in 10- and 14-day bismuth quadruple therapies and in 10-day sequential with standard-dose PPIs. Optimal second-line effectiveness was achieved with (1) metronidazole-tetracycline-bismuth quadruple therapy for 14- and 10 days with standard and high-dose PPIs, respectively; and (2) levofloxacin-amoxicillin triple therapy for 14 days with high-dose PPIs. None of the 7-day therapies in both treatment lines achieved optimal effectiveness. Conclusions: We recommend, in first-line treatment, the use of high-dose PPIs in 14-day triple therapy and in 10-or 14-day quadruple concomitant therapy in first-line treatment, while standard-dose PPIs would be sufficient in 10-day bismuth quadruple therapies. On the other hand, in second-line treatment, high-dose PPIs would be more beneficial in 14-day triple therapy with levofloxacin and amoxicillin or in 10-day bismuth quadruple therapy either as a three-in-one single capsule or in the traditional scheme.
2023
Role of proton pump inhibitors dosage and duration in Helicobacter pylori eradication treatment: Results from the European Registry on H. pylori management / Pabon-Carrasco M.; Keco-Huerga A.; Castro-Fernandez M.; Saracino I.M.; Fiorini G.; Vaira D.; Perez-Aisa A.; Tepes B.; Jonaitis L.; Voynovan I.; Lucendo A.J.; Lanas A.; Martinez-Dominguez S.J.; Almajano E.A.; Rodrigo L.; Vologzanina L.; Brglez Jurecic N.; Denkovski M.; Bujanda L.; Abdulkhakov R.A.; Huguet J.M.; Fernandez-Salazar L.; Alcaide N.; Velayos B.; Silkanovna Sarsenbaeva A.; Zaytsev O.; Ilchishina T.; Barrio J.; Bakulin I.; Perona M.; Alekseenko S.; Romano M.; Gravina A.G.; Nunez O.; Gomez Rodriguez B.J.; Ledro-Cano D.; Pellicano R.; Bogomolov P.; Dominguez-Cajal M.; Almela P.; Gomez-Camarero J.; Bordin D.S.; Gasbarrini A.; Kupcinskas J.; Cano-Catala A.; Moreira L.; Nyssen O.P.; Megraud F.; O'Morain C.; Gisbert J.P.. - In: UNITED EUROPEAN GASTROENTEROLOGY JOURNAL. - ISSN 2050-6406. - ELETTRONICO. - 12:1(2023), pp. 122-138. [10.1002/ueg2.12476]
Pabon-Carrasco M.; Keco-Huerga A.; Castro-Fernandez M.; Saracino I.M.; Fiorini G.; Vaira D.; Perez-Aisa A.; Tepes B.; Jonaitis L.; Voynovan I.; Lucendo A.J.; Lanas A.; Martinez-Dominguez S.J.; Almajano E.A.; Rodrigo L.; Vologzanina L.; Brglez Jurecic N.; Denkovski M.; Bujanda L.; Abdulkhakov R.A.; Huguet J.M.; Fernandez-Salazar L.; Alcaide N.; Velayos B.; Silkanovna Sarsenbaeva A.; Zaytsev O.; Ilchishina T.; Barrio J.; Bakulin I.; Perona M.; Alekseenko S.; Romano M.; Gravina A.G.; Nunez O.; Gomez Rodriguez B.J.; Ledro-Cano D.; Pellicano R.; Bogomolov P.; Dominguez-Cajal M.; Almela P.; Gomez-Camarero J.; Bordin D.S.; Gasbarrini A.; Kupcinskas J.; Cano-Catala A.; Moreira L.; Nyssen O.P.; Megraud F.; O'Morain C.; Gisbert J.P.
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