In this study, we evaluated the following differences Helicobacter pylori Diagnosis and treatment among older and younger people in Europe. We would like to point out that this analysis is one of the very few that can both assess an older population and allow for comparison with younger subjects. Furthermore, this is one of the few studies to provide data from such a large number of patients across Europe and is able to provide more accurate data and more reliable statistical results.
Our analysis confirmed the expected epidemiological hypothesis regarding baseline characteristics compared with younger patients; more elderly subjects were taking concomitant medications and a higher proportion reported allergy to penicillin.Although a higher number of concomitant medications and higher rates of drug allergies are generally associated with poorer treatment compliance33,34this was not confirmed in our study and had no impact on the efficacy of eradication therapy.
The diagnosis is Helicobacter pylori Also comply with current guidelines4.19 Study confirms that invasive diagnostic methods (histology, RUT) are more common for initial diagnosis Helicobacter pylori Prior to treatment, some of these approaches were also more common in the older population, as expected. To confirm eradication, UBT was the first choice for both age groups, followed by SAT.
Most of the research that has been done35,36,37 Studies have shown that quadruple therapy is superior to triple therapy in terms of effectiveness, and in fact, our study showed that quadruple therapy was more commonly used in first- and second-line treatment in both age groups. The most common treatment duration in both age groups was 10-14 days, in line with current guidelines.Treatment lasting 7 days is no longer recommended4,37,38 Although there were some cases with a treatment duration of 7 days in both age groups, as reported in the previous Hp-EuReg study and the Maastricht V/Florence consensus report, these cases were registered earlier in the registry , updated in 2016, no longer recommends a 7-day treatment period.
We would have expected that due to the higher likelihood of possible AEs (e.g. diarrhea, Clostridium difficile infection); however, we did not find any significant differences between age groups in PPI doses in first-line therapy, and the differences in second-line therapy were not clinically relevant. Multivariate analysis showed that high-dose PPIs were associated with better mITT rates in first- and second-line treatment; however, low-dose PPIs were most commonly used in first-line treatment in both age groups. We can speculate that some prescribing gastroenterologists are unfamiliar with the guidelines or wary of possible adverse events, especially in older patients. On the other hand, we should also point out that throughout the Hp-EuReg period, there is a clear transition from low-dose PPI to high-dose PPI.From the beginning of registration until 2017, low-dose PPIs dominated; however, since the release of the updated Maastricht V/Florence consensus report in 2017, the proportion of higher PPI doses began to increase, and is now dominated by high-dose Represented by PPI – accounting for almost half of Hp-EuReg cases39.
about Helicobacter pylori In eradication programmes, we can say that the use of the main first- and second-line prescriptions in older and younger European populations is in line with the recommendations of the Maastricht V/Florence consensus report. However, despite clarithromycin resistance rates >15% in many countries, the most commonly used first-line treatment in both age groups is standard triple therapy (PPI + C + A). As previously recommended, triple therapy containing levofloxacin was the most commonly used rescue regimen in both age groups.
One of the main goals of this study is to evaluate the effectiveness of major first- and second-line drugs Helicobacter pylori Eradication regime for older and younger groups. We found that the overall first-line treatment effect in younger subjects was very close to optimal eradication (≥ 90%) (89% for PP and 88% for mITT); whereas for older subjects, PP (90%) was optimal, and mITT (89%) is very close to optimal. The effectiveness of standard triple therapy (PPI + C + A), the most popular first-line prescription, was suboptimal in both age groups. Other triple therapies (PPI + C + M, PPI + A + L) did show worse efficacy. Optimal results are achieved only with bismuth- and non-bismuth-based quadruple therapies (PPI + C + A + B, PPI + C + A + T and single-capsule bismuth quadruple therapy (Pylera®)) and the most popular sequential therapy Eradication rates in two age groups of treatments (PPI+C+A+T).Other published studies have also confirmed the optimal effectiveness of these treatment options40,41,42. There were statistically significant differences in efficacy between age groups when using standard triple therapy (PPI + C + A), quadruple PPI + C + A + M, or sequential PPI + C + A + T therapy, but There were no differences among the remaining analyzed prescriptions. In this regard, it is worth mentioning that although there are statistically significant differences between different age groups in various parameters, including the effectiveness of different prescriptions, these differences may not be clinically significant and should be Interpret with caution, as most differences range from 1-2% and may simply be due to very large sample sizes. Therefore, in most cases we consider these differences to be clinically insignificant, although statistically significant.
The overall efficacy of second-line treatment for PP and mITT was unsatisfactory (84%) in both age groups. The effectiveness of the main second-line treatment regimen (PPI + A + L) was suboptimal in both age groups. In fact, the only regimen that achieved the best eradication rates in the elderly group was single-capsule bismuth quadruple therapy (Pylera®). In the younger group, the best eradication rates were achieved using triple PPI + A + Mx and quadruple PPI + C + A + B prescriptions. In fact, the only statistically significant difference in the efficacy of second-line treatment between older and younger patients was achieved with the previously mentioned prescription of the bismuth quadruple PPI + C + A + B (mITT 80% and 91%, respectively).
Multivariate analysis showed the expected results – non-bismuth agents, particularly bismuth-based quadruple therapies (most commonly PPI + C + A + B, single capsule Pylera® and PPI + C + A + M) were associated with associated with better efficacy. mITT cure rates for first-line therapy, our effectiveness analysis showed that most bismuth-containing regimens achieved optimal or near-optimal eradication rates.This has also been confirmed in other studies4,35,36,41,42 Current guidelines are moving toward bismuth-based quadruple therapy as primary therapy Helicobacter pylori Treatment programs4 Given that rates of clarithromycin resistance are increasing globally, it is recommended that23,43,44.
Another possible issue is that older subjects may have poorer treatment compliance, although this was not confirmed in our study. Although the older age group was associated with a higher number of concurrent medications, treatment compliance was very satisfactory at 97% in both age groups.
Interestingly, older adults experienced statistically significant fewer AEs compared with younger groups. However, we should consider whether this difference is indeed clinically relevant and could be due to the very large number of subjects in both age groups, as mentioned earlier. Nonetheless, both age groups demonstrated a similar safety profile (77% of older adults and 75% of younger adults did not have any AEs), with a slightly higher incidence of serious AEs in older subjects.
We can only compare our findings with some other similar studies that are available. A 2019 Japanese study also compared the diagnosis, efficacy, and safety of: Helicobacter pylori eradication by age group (young (≤ 65 years), old (65-74 years), and very old (≥ 75 years)). That study reported a similar eradication indication (chronic gastritis, PUD); however, the incidence of AEs was significantly lower in the elderly (9%) and very elderly groups (12%) compared with our study. Compared with our analysis, this study also reported better efficacy with the main standard triple therapy (PPI + A + C), achieving the best overall eradication rate (92%). When comparing age groups, very elderly patients had significantly fewer indications for chronic gastritis but more common indications for PUD than other groups. In the same Japanese study, Helicobacter pylori Eradication rates were not reduced in older patients compared with younger patients. No significant differences were observed in the efficacy of prescribed treatment regimens between groups, nor were significant differences observed in comparisons of AE incidence rates between groups.twenty one.Another small Chinese study also analyzed Helicobacter pylori Eradication was achieved between age groups by using bismuth-based quadruple therapy for 14 days, and ITT and PP analyzes also did not yield significant differences between age groups. The study also reported excellent eradication rates (>92%) in both age groupstwenty two.
One of the major weaknesses of our study is the possible heterogeneity of the data. Hp-EuReg currently covers 32 European countries, and different regions may have different management methods Helicobacter pylori infection, which may be influenced by factors such as the availability of local antimicrobial resistance rates, financial capabilities, availability of diagnostic methods, local antibiotic markets, and the knowledge and objectivity of the gastroenterologist. Our study includes a very large European cohort; providing accurate pan-European data.This is what happened in previously published studies of Hp-EuReg from different European countries39Despite the above concerns, it is important to recognize that multicenter collaboration to collect daily information on gastroenterology practice is one of the best ways to gain critical knowledge, including cases of patients who are even difficult to treat and to power statistical analyses.