Evolution of the use, effectiveness and safety of bismuth-containing quadruple therapy for Helicobacter pylori infection between 2013 and 2021: results from the European registry on H. pylori management (Hp-EuReg)

Authors	OLMEDO Llum CALVET Xavier GENÉ Emili BORDIN Dmitry S VOYNOVAN Irina CASTRO-FERNANDEZ M PABÓN-CARRASCO Manuel KECO-HUERGA Alma PEREZ-AISA Ángeles LUCENDO Alfredo J RODRIGO Luís SARSENBAEVA Aiman S KHLINOV Igor B FADIEIENKO Galyna ZAYTSEV Oleg LANAS Ángel MARTÍNEZ-DOMÍNGUEZ Samuel J ALFARO Enrique JONAITIS Laimas NÚNEZ Óscar PELLICANO Rinaldo HERNÁNDEZ Luis GRIDNYEV Oleksiy KUPCINSKAS Juozas GASBARRINI Antonio BOLTIN Doron NIV Yaron BABAYEVA Gülüstan MARCOS-PINTO Ricardo TEPES Bojan VENERITO Marino PAPP Veronika LERANG Frode LEJA Marcis PHULL Perminder S MARLICZ Wojciech DOULBERIS Michael SMITH Sinead M MILIVOJEVIC Vladimir KUNOVSKÝ Lumír MESTROVIC Antonio MATYSIAK-BUDNIK Tamara SIMSEK Halis CANO-CATALA Anna PUIG Ignasi MOREIRA Leticia PARRA Pablo NYSSEN Olga P MEGRAUD Francis O'MORAIN Colm GISBERT Javier P
Year of publication	2024
Type	Article in Periodical
Magazine / Source	Gut
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://gut.bmj.com/content/early/2024/11/11/gutjnl-2024-332804.long
Doi	http://dx.doi.org/10.1136/gutjnl-2024-332804
Description	Background Bismuth quadruple therapies (BQTs) including bismuth, a proton pump inhibitor (PPI) and two antibiotics have been shown to be highly effective for treating Helicobacter pylori infection even in areas of high bacterial antibiotic resistance. Objective To describe the time trends of use, effectiveness and safety of BQT in Europe using the European Registry on Helicobacter pylori Management (Hp-EuReg). Design Patients registered in the Hp-EuReg from 2013 to 2021 who had received BQT were included. The regimens prescribed, the number of eradication attempts, effectiveness, adherence and safety were analysed. The effectiveness was assessed by modified intention to treat (mITT). Time-trend and multivariate analyses were performed to determine variables that predicted treatment success. Results Of the 49?690 patients included in the Hp-EuReg, 15?582 (31%) had received BQT. BQT use increased from 8.6% of all treatments in 2013 to 39% in 2021. Single-capsule BQT—containing bismuth, metronidazole and tetracycline—plus a PPI (single-capsule BQT, ScBQT) was the most frequent treatment mode (43%). Schemes that obtained an effectiveness above 90% were the 10-day ScBQT and 14-day BQT using tetracycline plus metronidazole, or amoxicillin plus either clarithromycin or metronidazole. Only ScBQT achieved above 90% cure rates in all the geographical areas studied. Using the ScBQT scheme, adherence, the use of standard or high-dose PPIs, 14-day prescriptions and the use of BQT as first-line treatment were significantly associated with higher mITT effectiveness. Conclusion The use of BQT increased notably in Europe over the study period. A 10-day ScBQT was the scheme that most consistently achieved optimal effectiveness.