• Olga P Nyssen, Dmitry Bordin, Bojan Tepes, Ángeles Pérez-Aisa, Dino Vaira, Maria Caldas, Luis Bujanda, Manuel Castro-Fernandez, Frode Lerang, Marcis Leja, Luís Rodrigo, Theodore Rokkas, Limas Kupcinskas, Jorge Pérez-Lasala, Laimas Jonaitis, Oleg Shvets, Antonio Gasbarrini, Halis Simsek, AxonAnthony T RATRGastroenterology, Leeds General Infirmary, Leeds, UK., György Buzás, Jose Carlos Machado, Yaron Niv, Lyudmila Boyanova, Adrian Goldis, Vincent Lamy, Ante Tonkic, Krzysztof Przytulski, Christoph Beglinger, Marino Venerito, Peter Bytzer, Lisette Capelle, Tomica Milosavljević, Vladimir Milivojevic, Lea Veijola, Javier Molina-Infante, Liudmila Vologzhanina, Galina Fadeenko, Ines Ariño, Giulia Fiorini, Ana Garre, Jesús Garrido, Cristina F Pérez, Ignasi Puig, Frederic Heluwaert, Francis Megraud, Colm O'Morain, Javier P Gisbert, and Hp-EuReg Investigators.
• Gastroenterolgy Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Madrid, Spain.
• Gut. 2021 Jan 1; 70 (1): 40-54.

ObjectiveThe best approach for Helicobacter pylori management remains unclear. An audit process is essential to ensure clinical practice is aligned with best standards of care.DesignInternational 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. Variables included demographics, previous eradication attempts, prescribed treatment, adverse events and outcomes. Data monitoring was performed to ensure data quality. Time-trend and geographical analyses were performed.Results30 394 patients from 27 European countries were evaluated and 21 533 (78%) first-line empirical H. pylori treatments were included for analysis. Pretreatment resistance rates were 23% to clarithromycin, 32% to metronidazole and 13% to both. Triple therapy with amoxicillin and clarithromycin was most commonly prescribed (39%), achieving 81.5% modified intention-to-treat eradication rate. Over 90% eradication was obtained only with 10-day bismuth quadruple or 14-day concomitant treatments. Longer treatment duration, higher acid inhibition and compliance were associated with higher eradication rates. Time-trend analysis showed a region-dependent shift in prescriptions including abandoning triple therapies, using higher acid-inhibition and longer treatments, which was associated with an overall effectiveness increase (84%-90%).ConclusionManagement of H. pylori infection by European gastroenterologists is heterogeneous, suboptimal and discrepant with current recommendations. Only quadruple therapies lasting at least 10 days are able to achieve over 90% eradication rates. European recommendations are being slowly and heterogeneously incorporated into routine clinical practice, which was associated with a corresponding increase in effectiveness.© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

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