Assessment of first-line eradication treatment in Greece: data from the European Registry on Helicobacter pylori management (Hp-EuReg)

Theodore Rokkas; Sotirios Georgopoulos; Spyros Michopoulos; Vasiliki Ntouli; Christos Liatsos; Ignasi Puig; Olga P. Nyssen; Francis Mégraud; Colm O'Morain; Javier P. Gisbert

Authors Theodore Rokkas, Sotirios Georgopoulos, Spyros Michopoulos, Vasiliki Ntouli, Christos Liatsos, Ignasi Puig, Olga P. Nyssen, Francis Mégraud, Colm O'Morain, Javier P. Gisbert.

Abstract

Background Helicobacter pylori (H. pylori) is the most common chronic bacterial infection. Its management has to rely on local effectiveness, given the geographical variability of bacterial antibiotic resistance. We evaluated treatment effectiveness in naïve patients in Greece, as part of the European Registry on the management of H. pylori (Hp-EuReg).

Methods Patients were registered in the AEG-REDCap Electronic Case Report Form from 2013- 2020. All cases with a first-line treatment were included. Modified intention-to-treat (mITT) analysis was used.

Results A total of 547 patients from 5 medical institutions were treated with the following regimens: concomitant with proton pump inhibitors (PPIs), clarithromycin, amoxicillin and metronidazole (concomitant-C+A+M) (38%); hybrid with PPI, clarithromycin, amoxicillin and metronidazole (hybrid-C+A+M) (20%); sequential with PPI, clarithromycin, amoxicillin and tinidazole (sequential-C+A+T) (12%); sequential with PPI, clarithromycin, amoxicillin and metronidazole (sequential-C+A+M) (12%); concomitant with PPI, clarithromycin, amoxicillin and tinidazole (concomitant-C+A+T) (8%); triple with PPI, clarithromycin and amoxicillin (triple-C+A) (7%); and other (3%). Overall compliance was 99%. Triple-C+A, sequential-C+A+T, sequential-C+A+M and concomitant-C+A+T were used from 2013-2015. The respective mITT cure rates (95% confidence interval) were 92% (78-98), 87% (76-94), 67% (54-78) and 91% (79-98). Since 2015, patients were also treated with concomitant-C+A+M and hybrid-C+A+M regimens, with respective mITT cure rates of 90% (85-94) and 88% (80.5-94). Adverse events were reported by 31% of the patients, dysgeusia being the most frequent (15%).

Conclusions “Optimized” H. pylori therapies should achieve cure rates over 90%. In Greece, at present, only non-bismuth quadruple concomitant regimens achieve this target and can be recommended as first-line treatment.

Keywords Helicobacter pylori, treatment, Greece, Hp-EuReg

Ann Gastroenterol 2022; 35 (1): 42-47