2024-09-03 09:15:54
A new study aimed to evaluate the effect of indications for the diagnosis of Helicobacter pylori bacteria on prescriptions, effectiveness, compliance and tolerance of eradication therapy.
The study has been led by Samuel J. Martínez-Domínguez, gastroenterologist at Lozano Blesa University Clinical Hospital in Zaragoza in Spain, with Javier P. Gisbert and Olga P. Nyssen, Principal Investigator and Scientific Director of the European Registry on the management. of Helicobacter pylori infection (Hp-EuReg), respectively, the latter two belonging to the Biomedical Research Network for Liver and Digestive Diseases (CIBEREHD) and the Princesa Health Research Institute (IIS-Princesa) of the University Hospital of La Princesa from Madrid, in Spain. In addition, the publication has the participation of very different institutions throughout Europe, including many patients.
We extracted data from Hp-EuReg, a European multicenter prospective project of the clinical practice of gastroenterologists.
53,636 treatment-naïve patients registered between May 2013 and July 2023, from 34 European countries, incl. It is noted that the most frequent indications are: dyspepsia with normal endoscopy (49% of cases), undiagnosed dyspepsia (20%), duodenal ulcer (11%), gastric ulcer (7.7%), gastroesophageal reflux (2, 6 %). and preneoplastic lesions (2.5%).
In the period 2013-2023, quadruple therapy with metronidazole, tetracycline and bismuth (including a capsule format and traditional format) increased its use in all indications, as did quadruple therapy with clarithromycin, amoxicillin and bismuth. The opposite occurred for subsequent therapy consisting of clarithromycin, amoxicillin and tinidazole/metronidazole, whose use was reduced in all indications. In the case of quadruple therapy with clarithromycin, amoxicillin and tinidazole/metronidazole, an increase in prescriptions for the indication of gastroesophageal reflux was observed, and a decrease for the rest of the indications, as with triple therapy containing clarithromycin and amoxicillin. In the case of triple therapy with clarithromycin and metronidazole, its use decreased in many indications over the years, while an increase was observed for the indication of gastric ulcer and gastroesophageal reflux (the latter only in the years 2015-2016).
From left to right: Javier P. Gisbert (researcher at IIS-Princesa and CIBEREHD) Olga P. Nyssen (researcher at IIS-Princesa and CIBEREHD) and Samuel J. Martínez-Domínguez (Researcher at Hospital Clínico Universitario Lozano Blesa). (Photos: IIS-Princesa / CIBER / Lozano Blesa University Clinical Hospital)
The effectiveness of treatment based on the indication is also studied. Triple therapy with clarithromycin and amoxicillin, and with clarithromycin and metronidazole, did not achieve an optimal elimination rate (90% or more) for any of the indications. Sequential quadruple therapy with clarithromycin, amoxicillin and tinidazole/metronidazole achieved the best clearance rate for gastric ulcer indication. Quadruple therapy with clarithromycin, amoxicillin and tinidazole/metronidazole obtained optimal clearance rates for all indications, except in patients with undiagnosed dyspepsia. Four therapies including metronidazole, tetracycline and bismuth, and including clarithromycin, amoxicillin and bismuth, also achieved optimal clearance rates for all indications, except gastroesophageal reflux.
Adverse events suffered were also analyzed based on indication for treatment. We note that in patients whose indication is dyspepsia with normal endoscopy or duodenal ulcer, the incidence of adverse events is higher compared to other indications. Compliance with each therapeutic regimen was also studied based on the indication, noting the best results when triple therapy with clarithromycin and amoxicillin or quadruple therapy with clarithromycin, amoxicillin and bismuth were prescribed, and indicated for treatment are preneoplastic lesions.
Finally, the authors of the study concluded that the patients indicated for treatment are stomach ulcers or duodenal ulcers and preneoplastic ulcers received maximum effect, and four therapies with and without bismuth achieved the best results in almost all references.
The study is entitled “Indicators of Helicobacter pylori Treatment and Its Effect on Licenses and Improvement (Hp-EuReg)”. And it was published in the Helicobacter academic journal. (Source: IIS-Princesa / CIBER)
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