Helicobacter pylori infection is the main cause of chronic gastritis


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Helicobacter pylori infection is the main cause of chronic gastritis and one of the main causes of peptic ulcer. In addition, it is the only bacterium classified as a Class I carcinogen by the World Health Organization (WHO) and is a major factor in the development of adenocarcinoma and gastric lymphoma.

Reduce disease rates

Although the prevalence of Helicobacter pylori is declining, especially among younger people, it is estimated that approximately 50% of the world’s population is still infected by this bacterium. The prevalence of Helicobacter pylori is related to the cohort effect, that is, the older the cohort, the higher the infection rate.

Currently, there is a lack of data not only on the diagnosis and treatment of H. pylori in the elderly population, but also data comparing outcomes with younger subjects, which could further assess population characteristics and potentially aid in treatment adaptation. Different age groups.

Therefore, this study aimed to evaluate and compare the diagnostic methods and treatment prescriptions for Helicobacter pylori infection and the effectiveness of the most common first- and second-line eradication regimens in older and younger European populations.

To achieve this, data from the European prospective multicentre observational project “European Helicobacter pylori Infection Management Registry (Hp-EuReg)” were used. For this purpose, we analyzed all cases registered between 2013 and 2022 and divided them into two groups: over 60 years of age and under 60 years of age.

49,461 patients were included, 14,467 (29%) of whom were older than 60 years, and concomitant drug use and penicillin allergy were more common in this subgroup of patients. First-line treatment indications, treatment duration, and use of certain treatment regimens (standard amoxicillin-clarithromycin triple therapy, quadruple clarithromycin-amoxicillin-metronidazole, or sequential-clarithromycin-clarithromycin- metronidazole). amoxicillin-tinidazole), and dosing of proton pump inhibitors (in second line only).

However, none of these statistical differences are considered clinically relevant. The incidence of adverse reactions was lower in the elderly group. No differences in compliance were observed between groups.

The overall modified intention-to-treat (mITT) effectiveness of first-line treatment was 90% in older adults and 88% in younger adults. The overall effective rate of second-line treatment in both groups was 84%. The effectiveness of first- and second-line triple therapy was suboptimal in both groups, and only quadruple therapy with or without bismuth achieved optimal eradication rates (=90%).

best eradication

In summary, the researchers concluded that no clinically relevant differences were observed between age groups in the effectiveness of first- and second-line therapies in Europe; optimal eradication was achieved with quadruple therapy with or without bismuth Rate.

The study was led by Javier Gisbert (IIS-Princesa/ H. de La Princesa), a researcher in the CIBER Area of ​​Liver and Digestive Diseases (CIBEREHD), together with Paulius Jonaitis, a gastroenterologist at the Lithuanian University of Health Sciences in Kaunas. Also involved in the study were CIBEREHD researchers – Olga Nyssen, IIS-Princesa; Leticia Moreira, H. Clínic de Barcelona and Luis Bujanda, H. Biodonostia -, as well as other European institutions.

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