Role of proton pump inhibitors dosage and duration in Helicobacter pylori eradication treatment: Results from the European Registry on H. pylori management.
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| 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.
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| Authors | Manuel Pabón-Carrasco, Alma Keco-Huerga, Manuel Castro-Fernández, Ilaria Maria Saracino, Giulia Fiorini, Dino Vaira, Ángeles Pérez-Aísa, Bojan Tepes, Laimas Jonaitis, Irina Voynovan, Alfredo J Lucendo, Ángel Lanas, Samuel J Martínez-Domínguez, Enrique Alfaro Almajano, Luis Rodrigo, Ludmila Vologzanina, Natasa Brglez Jurecic, Maja Denkovski, Luis Bujanda, Rustam A Abdulkhakov, Jose M Huguet, Luis Fernández-Salazar, Noelia Alcaide, Benito Velayos, Aiman Silkanovna Sarsenbaeva, Oleg Zaytsev, Tatiana Ilchishina, Jesús Barrio, Igor Bakulin, Monica Perona, Sergey Alekseenko, Marco Romano, Antonietta G Gravina, Óscar Núñez, Blas José Gómez Rodríguez, Diego Ledro-Cano, Rinaldo Pellicano, Pavel Bogomolov, Manuel Domínguez-Cajal, Pedro Almela, Judith Gomez-Camarero, Dmitry S Bordin, Antonio Gasbarrini, Juozas Kupčinskas, Anna Cano-Català, Leticia Moreira, Olga P Nyssen, Francis Mégraud, Colm O'Morain, Javier P Gisbert, Hp-EuReg Investigators |
| Journal | United European gastroenterology journal (United European Gastroenterol J) Vol. 12 Issue 1 Pg. 122-138 (02 2024) ISSN: 2050-6414 [Electronic] England |
| PMID | 38050339 (Publication Type: Journal Article) |
| Copyright | © 2023 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC. on behalf of United European Gastroenterology. |
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