First-­line­ H. pylori eradication therapy in Europe: Results from 24,882 cases of the European Registry on H. pylori Management­(Hp-­EuReg)

Background: The best approach for Helicobacter pylori management remains unclear. An audit process is essential to ensure clinical practice is aligned with best standards of care. Design: International multicentre prospective non- interventional registry starting in 2013 aimed to evaluate the decisions and outcomes in H. pylori management by European gastroenterologists. Patients were registered in an e-CRF by AEG-REDCap up to April 2020. Variables included: demographics, previous eradication at-tempts, prescribed treatment, adverse events, and outcomes. Modified intention-to-treat (mITT) and per- protocol (PP) analyses were performed and data were subject to quality review to ensure information reliability. Results: In total 36, 319 patients from 29 European countries were evaluated and 24, 882 (70%) first-line empirical H. pylori treatments were included for analysis. Triple therapy with amoxicillin and clarithromycin was most commonly prescribed (40%), followed by concomitant treatment (19%) and bismuth quadruple (Pylera®) (10%) achieving 83%, 91% and 95% mITT eradication rate, respectively. Over 90% effectiveness was obtained only with 10 and 14-day bismuth quadruple or 14-day concomitant treatment. Longer treatment duration, higher acid inhibition and compliance were associated with higher eradication rates. Conclusions: Management of H. pylori infection by European gastroenterologists is heterogeneous. Only quadruple therapies lasting at least 10 days are able to achieve over 90% eradication rates.