The effectiveness of treatments against the Helicobacter pylori bacteria

A new study aimed to assess the effect of Helicobacter pylori screening guidelines on the prescription, effectiveness, compliance and tolerance of eradication treatment.

The study was led by Samuel J. Martínez-Domínguez, gastroenterologist at the Hospital Clínico Universitario Lozano Blesa in Zaragoza, Spain, together 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 Centre for Liver and Digestive Diseases (CIBEREHD) and the Princesa Health Research Institute (IIS-Princesa) of the Hospital Universitario de La Princesa in Madrid, Spain. In addition, the publication has had the participation of very diverse institutions from all over Europe, including a wide range of patients.

Data were extracted from Hp-EuReg, a European multicentre prospective project on the clinical practice of gastroenterologists.

A total of 53,636 treatment-naive patients registered between May 2013 and July 2023 from 34 European countries were included. The most frequent indications were: dyspepsia with normal endoscopy (49% of cases), uninvestigated 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 its single capsule form and its traditional form) increased its use in all indications, as did quadruple therapy with clarithromycin, amoxicillin and bismuth. The opposite occurred for sequential therapy composed of clarithromycin, amoxicillin and tinidazole/metronidazole, the use of which decreased in all indications. In the case of quadruple therapy with clarithromycin, amoxicillin and tinidazole/metronidazole, an increase in prescriptions was observed for the indication of gastroesophageal reflux, and a decrease for the other indications, as well as for triple therapy composed of clarithromycin and amoxicillin. In the case of triple therapy with clarithromycin and metronidazole, its use decreased in most 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 the IIS-Princesa and CIBEREHD), Olga P. Nyssen (researcher at the IIS-Princesa and CIBEREHD) and Samuel J. Martínez-Domínguez (researcher at the Lozano Blesa University Clinical Hospital). (Photos: IIS-Princesa / CIBER / Lozano Blesa University Clinical Hospital)

The effectiveness of treatments was also studied according to the indication. Triple therapies with clarithromycin and amoxicillin and with clarithromycin and metronidazole did not achieve an optimal eradication rate (90% or more) for any of the indications. Sequential quadruple therapy with clarithromycin, amoxicillin and tinidazole/metronidazole achieved an optimal eradication rate for the gastric ulcer indication. Concomitant quadruple therapy with clarithromycin, amoxicillin and tinidazole/metronidazole achieved optimal eradication rates for all indications except in those patients with uninvestigated dyspepsia. Quadruple therapies with metronidazole, tetracycline and bismuth and with clarithromycin, amoxicillin and bismuth also achieved optimal eradication rates for all indications except gastroesophageal reflux.

Adverse events were also analysed based on the indication for treatment. It was observed that in patients whose indication was dyspepsia with normal endoscopy or duodenal ulcer, the incidence of adverse events was higher compared to the other indications. Compliance with each therapeutic regimen was also studied based on the indication, observing the best results when triple therapy with clarithromycin and amoxicillin or quadruple therapy with clarithromycin, amoxicillin and bismuth was prescribed, and the indication for treatment was preneoplastic lesions.

Finally, the authors of the study concluded that patients whose treatment indication is gastric or duodenal ulcers and preneoplastic lesions, obtain greater effectiveness of the treatment, and that quadruple therapies with and without bismuth achieve optimal results in almost all indications.

The study is titled “Indications of Helicobacter pylori Eradication Treatment and Its Influence on Prescriptions and Effectiveness (Hp-EuReg)”. It has been published in the academic journal Helicobacter. (Source: IIS-Princesa / CIBER)