| Autor: |
Nyssen, Olga P, Bordin, Dmitry, Tepes, Bojan, Pérez-Aisa, Ángeles, Vaira, Dino, Caldas, Maria, Bujanda, Luis, Castro-Fernandez, Manuel, Lerang, Frode, Leja, Marcis, Rodrigo, Luís, Rokkas, Theodore, Kupcinskas, Limas, Pérez-Lasala, Jorge, Jonaitis, Laimas, Shvets, Oleg, Gasbarrini, Antonio, Simsek, Halis, Axon, Anthony T R, Buzás, Gyo¨rgy, Machado, Jose Carlos, Niv, Yaron, Boyanova, Lyudmila, Goldis, Adrian, Lamy, Vincent, Tonkic, Ante, Przytulski, Krzysztof, Beglinger, Christoph, Venerito, Marino, Bytzer, Peter, Capelle, Lisette, Milosavljević, Tomica, Milivojevic, Vladimir, Veijola, Lea, Molina-Infante, Javier, Vologzhanina, Liudmila, Fadeenko, Galina, Ariño, Ines, Fiorini, Giulia, Garre, Ana, Garrido, Jesús, F Pérez, Cristina, Puig, Ignasi, Heluwaert, Frederic, Megraud, Francis, O'Morain, Colm, Gisbert, Javier P |
| Zdroj: |
Gut; 2021, Vol. 70 Issue: 1 p40-54, 15p |
| Abstrakt: |
ObjectiveThe best approach for Helicobacter pylorimanagement remains unclear. An audit process is essential to ensure clinical practice is aligned with best standards of care.DesignInternational multicentre prospective non-interventional registry starting in 2013 aimed to evaluate the decisions and outcomes in H. pylorimanagement 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.Results30 394 patients from 27 European countries were evaluated and 21 533 (78%) first-line empirical H. pyloritreatments 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%).ConclusionManagement of H. pyloriinfection 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. |
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