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1. The Role of Statins on Helicobacter pylori Eradication: Results from the European Registry on the Management of H. pylori (Hp-EuReg)

Author

María Caldas, Ángeles Pérez-Aisa, Bojan Tepes, Alma Keco-Huerga, Luis Bujanda, Alfredo J. Lucendo, Luis Rodrigo, Dino Vaira, Luis Fernández-Salazar, Jose M. Huguet, Jorge Pérez-Lasala, Natasa Brglez Jurecic, Galina Fadeenko, Jesús Barrio, Miguel Areia, Juan Ortuño, Rinaldo Pellicano, Marcis Leja, Javier Molina-Infante, Pavel Bogomolov, Sergey Alekseenko, Manuel Domínguez-Cajal, Judith Gómez-Camarero, Vassiliki Ntouli, Samuel J. Martínez-Domínguez, Rafael Ruiz-Zorrilla, Oscar Núñez, Aiman Silkanovna Sarsenbaeva, Pedro Almela, Perminder Phull, Marta Espada, Ignasi Puig, Olga P. Nyssen, Francis Mégraud, Colm O’Morain, Javier P. Gisbert, and on behalf of the Hp-EuReg Investigators

Subjects
statins, Helicobacter pylori, treatment, Therapeutics. Pharmacology, RM1-950
Abstract

Statins could increase the effectiveness of Helicobacter pylori eradication therapies due to their anti-inflammatory effect. The aim of this study was to analyze the impact of this therapeutic association in real life. This is a multicenter, prospective, non-interventional study aimed at evaluating the management of H. pylori by European gastroenterologists. Patients were registered in an e-CRF by AEG-REDCap from 2013 to 2020. The association between statin use and H. pylori eradication effectiveness was evaluated through multivariate analysis. Overall, 9988 and 705 patients received empirical and culture-guided treatment, respectively. Overall, statin use was associated with higher effectiveness in the empirical group (OR = 1.3; 95%CI = 1.1–1.5), but no association was found with first-line treatment effectiveness (N = 7738); as an exception, statin use was specifically associated with lower effectiveness of standard triple therapy (OR = 0.76; 95%CI = 0.59–0.99). In the rescue therapy empirical group (N = 2228), statins were associated with higher overall effectiveness (OR = 1.9; 95%CI = 1.4–2.6). However, sub-analyses by treatment schemes only confirmed this association for the single-capsule bismuth quadruple therapy (OR = 2.8; 95%CI = 1.3–5.7). No consistent association was found between statin use and H. pylori therapy effectiveness. Therefore, the addition of statins to the usual H. pylori treatment cannot be currently recommended to improve cure rates.

Published
2021
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2. European Registry on Helicobacter pylori Management: Effectiveness of First and Second-Line Treatment in Spain

Author

María Caldas, Ángeles Pérez-Aisa, Manuel Castro-Fernández, Luis Bujanda, Alfredo J. Lucendo, Luis Rodrigo, Jose M. Huguet, Jorge Pérez-Lasala, Javier Molina-Infante, Jesús Barrio, Luis Fernández-Salazar, Ángel Lanas, Mónica Perona, Manuel Domínguez-Cajal, Juan Ortuño, Blas José Gómez-Rodríguez, Pedro Almela, Josep María Botargués, Óscar Núñez, Inés Modolell, Judith Gómez, Rafael Ruiz-Zorrilla, Cristóbal De la Coba, Alain Huerta, Eduardo Iyo, Liliana Pozzati, Rosario Antón, Mercé Barenys, Teresa Angueira, Miguel Fernández-Bermejo, Ana Campillo, Javier Alcedo, Ramón Pajares-Villaroya, Marianela Mego, Fernando Bermejo, José Luis Dominguez-Jiménez, Llúcia Titó, Nuria Fernández, Manuel Pabón-Carrasco, Ángel Cosme, Pilar Mata-Romero, Noelia Alcaide, Inés Ariño, Tommaso Di Maira, Ana Garre, Ignasi Puig, Olga P. Nyssen, Francis Megraud, Colm O’Morain, and Javier P. Gisbert

Subjects
Helicobacter pylori, treatment, first-line, second-line, Spain, Therapeutics. Pharmacology, RM1-950
Abstract

The management of Helicobacter pylori infection has to rely on previous local effectiveness due to the geographical variability of antibiotic resistance. The aim of this study was to evaluate the effectiveness of first and second-line H. pylori treatment in Spain, where the empirical prescription is recommended. A multicentre prospective non-interventional registry of the clinical practice of European gastroenterologists concerning H. pylori infection (Hp-EuReg) was developed, including patients from 2013 until June 2019. Effectiveness was evaluated descriptively and through a multivariate analysis concerning age, gender, presence of ulcer, proton-pump inhibitor (PPI) dose, therapy duration and compliance. Overall, 53 Spanish hospitals were included, and 10,267 patients received a first-line therapy. The best results were obtained with the 10-day bismuth single-capsule therapy (95% cure rate by intention-to-treat) and with both the 14-day bismuth-clarithromycin quadruple (PPI-bismuth-clarithromycin-amoxicillin, 91%) and the 14-day non-bismuth quadruple concomitant (PPI-clarithromycin-amoxicillin-metronidazole, 92%) therapies. Second-line therapies were prescribed to 2448 patients, with most-effective therapies being the triple quinolone (PPI-amoxicillin-levofloxacin/moxifloxacin) and the bismuth-levofloxacin quadruple schemes (PPI-bismuth-levofloxacin-amoxicillin) prescribed for 14 days (92%, 89% and 90% effectiveness, respectively), and the bismuth single-capsule (10 days, 88.5%). Compliance, longer duration and higher acid inhibition were associated with higher effectiveness. “Optimized” H. pylori therapies achieve over 90% success in Spain.

Published
2020
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3. Ovesco system for treatment of postpolypectomy bleeding after failure of conventional treatment

Author

Noelia Alcaide, Irene Peñas-Herrero, Lorena Sancho-del-Val, Rafael Ruiz-Zorrilla, Jesús Barrio, and Manuel Pérez-Miranda

Subjects
Ovesco, Clip de nitinol, Hemostasia, Hemorragia gastrointestinal, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

The clip Ovesco (Ovesco, Tübingen, Germany) is a novel endoscopic method for mechanical compression of tissue in the gastrointestinal tract. The indications for treatment are closure of perforations and fistulas and control of bleeding in which the conventional endoscopic treatment has failed. We report two cases about the use of an Ovesco (over-the-scope clip, OTSC) system to control persistent bleeding postpolypectomy after failure of usual treatment.

Published
2014
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5. Ovesco system for treatment of postpolypectomy bleeding after failure of conventional treatment

Author

Irene Penas-Herrero, Noelia Alcaide, Lorena Sancho-del-Val, Rafael Ruiz-Zorrilla, Manuel Perez-Miranda, and Jesús Barrio

Subjects
medicine.medical_specialty, Colonic Polyps, Postoperative Hemorrhage, Hemorragia gastrointestinal, Endoscopy, Gastrointestinal, Mechanical compression, Hemostasia, Humans, Medicine, lcsh:RC799-869, Gastrointestinal bleeding, Aged, Hemostasis, medicine.diagnostic_test, business.industry, Gastroenterology, Conventional treatment, General Medicine, Surgical Instruments, Surgery, Endoscopy, Nitinol clip, Female, lcsh:Diseases of the digestive system. Gastroenterology, business, Endoscopic treatment, Clip de nitinol, Ovesco
Abstract

The clip Ovesco (Ovesco, Tübingen, Germany) is a novel endoscopic method for mechanical compression of tissue in the gastrointestinal tract. The indications for treatment are closure of perforations and fistulas and control of bleeding in which the conventional endoscopic treatment has failed. We report two cases about the use of an Ovesco (over-the-scope clip, OTSC) system to control persistent bleeding postpolypectomy after failure of usual treatment.

Published
2014

7. European Registry on Helicobacter pylori management (Hp-EuReg): patterns and trends in first-line empirical eradication prescription and outcomes of 5 years and 21 533 patients

Author

Nyssen OP, Bordin D, Tepes B, Pérez-Aisa Á, Vaira D, Caldas M, Bujanda L, Castro-Fernandez M, Lerang F, Leja M, Rodrigo L, Rokkas T, Kupcinskas L, Pérez- Lasala J, Jonaitis L, Shvets O, Gasbarrini A, Simsek H, Axon ATR, Buzás G, Machado JC, Niv Y, Boyanova L, Goldis A, Lamy V, Tonkic A, Przytulski K, Beglinger C, Venerito M, Bytzer P, Capelle L, Milosavljević T, Milivojevic V, Veijola L, Molina-Infante J, Vologzhanina L, Fadeenko G, Ariño I, Fiorini G, Garre A, Garrido J, F Pérez C, Puig I, Heluwaert F, Megraud F, O'Morain C, Gisbert JP, Romano M, Universidad Autónoma de Madrid (UAM), AS Loginov Moscow Clinical Scientific Center [Moscow, Russian Federation], A.I. Yevdokimov Moscow State University of Medicine and Dentistry [Moscow, Russian Federation], AM DC Rogaska [Rogaska Slatina, Slovenia], Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), University of Bologna/Università di Bologna, Universidad del Pais Vasco / Euskal Herriko Unibertsitatea [Espagne] (UPV/EHU), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Liver Unit, Clínica Universitaria, CIBER-EHD, Østfold Hospital, University of Latvia (LU), Universidad de Oviedo [Oviedo], Henry Dunant Hospital [Athens, Greece], Lithuanian University of Health Sciences [Kaunas, Lithuania], Hospital Universitario HM Sanchinarro [Madrid, Spain], Università cattolica del Sacro Cuore = Catholic University of the Sacred Heart [Roma] (Unicatt), Faculty of Medicine [Hacettepe University], Hacettepe University = Hacettepe Üniversitesi, Leeds General Infirmary (LGI), Leeds Teaching Hospitals NHS Trust, Ferencváros Health Centre [Budapest, Hungary], Faculdade de Medicina da Universidade do Porto (FMUP), Universidade do Porto = University of Porto, Tel Aviv University (TAU), Medical University of Sofia [Bulgarie], Timisoara Hospital [Timisoara, Romania], Centre Hospitalier Universitaire de Charleroi, University of Split, Medical Centre for Postgraduate Education [Warsaw, Poland], University Hospital Basel [Basel], Otto-von-Guericke-Universität Magdeburg = Otto-von-Guericke University [Magdeburg] (OVGU), Copenhagen University Hospital, Meander Medical Center [Amersfoort, Netherlands], University of Belgrade [Belgrade], Herttoniemi Hospital [Helsinki, Finland], San Pedro de Alcantara Hospital [Cáceres, Espagne], Gastrocentr [Perm, Russian Federation], Digestive Ukrainian Academy of Medical Sciences [Kyiv, Ukraine], Hospital Clínico Universitario 'Lozano Blesa' [Zaragoza, Spain], Althaia Xarxa Assistencial Universitària de Manresa [Manresa, Spain], Universitat de Vic-Universitat Central de Catalunya [Manresa, Spain] (UVicUCC), Complejo Hospitalario Universitario de Santiago de Compostela [Saint-Jacques-de-Compostelle, Espagne] (CHUS), Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Physiopathologie du cancer du foie, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Pellegrin, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Trinity College Dublin, Hp-EuReg Investigators: Jen Hinojosa, Inmaculada Santaella, Nuria Fernandez Moreno, Ilaria Maria Saracino, Horacio Alonso Galán, Almudena Durán, Jennifer Fernandez Pacheco, Miroslav Vujasinovic, Rinaldo Pellicano Molinette, Zdenko Kikec, Pedro-Luis Gonzalez Cordero, Maia Donday, Polona Lampic, Vid Leban, Aleksander Gruncic Krajnc, Natasa Brglez Jurecic, Galyna Dmytrivna Fadieienko, Lorena Lee, Irene V Barbado, Alfredo José Lucendo, Alfredo José Lucendo, Jesus Barrio RIo Hortega, Tatiana Alekseevna Ilchishina, Irina Voynovan, Luis Ignacio Fernández-Salazar, Jose María Huguet, Pilar Canelles, Aiman Silkanovna Sarsenbaeva, Ines Modolell Consorci, Pedro Almela, Marina Roldán Lafuente, Josep Maria Botargues, Miguel Areia, Luís Elvas, Susana Isabel Alves, Daniel Brito, Ana Teresa Cadime, Sandra Lúcia Madeira Saraiva, Charalampos Tzathas, Vassiliki Ntouli, Alicia C Marin, Cem Simsek, Alba Rocco, Juan Antonio Ortuño, Tommaso Di Maira, Sotirios D Georgopoulos, Stephan Brackmann, Vendel Kristensen Lovisenberg, Blas Jose Gomez-Rodriguez, Perminder Singh Phull, Sergey Alekseyevich, Monica Perona, Rustam Abdulkhakov, Deirdre McNamara, Sinead M Smith, Denise Elizabeth Brennan, Marina Fedorovna Osipenko, Cristobal de la Coba, Pilar Varela, Maria Anatolyevna Livzan, Oleg V Zaytsev, Vladislav Vladimirovich Tsukanov, Alexander Viktorovich Vasyutin, Olga Sergeevna Amelchugova, Spiros Michopoulus, Sergey Gennadievich Burkov, Dan Dumitrascu, Bogdan Ianosi, Ingrid Prytz Berset, Rafael Ruiz-Zorrilla Lopez, Charo Antón, Anne Courillon-Mallet, Natasa Brglez Jurecic, Judith Gomez-Camarero, Manuel Jimenez-Moreno, Ahmet Uygun, Ian Leonard Phillip Beales, Alain Huerta-Madrigal, Javier Alcedo, Mercè Barenys, Francesco Franceschi, Jean-Charles Delchier, Liliana Silvia Pozzati, Monika Augustyn, Maja Seruga, Miriam Hiestand, Patric Mosler, Zaza Beniashvili, Doron Boltin, Hubert Louis, Ramon Pajares, Natalia Valerievna Zakharova, Natalia Nikolaevna Dekhnich, Victor Asparuhov Kamburov, Maria Pina Dore, Lorena Sancho, Oscar Núñez, Katrine Dvergsnes Sørlandet, Peter Malfertheiner, Ana Campillo, Miguel Fernandez-Bermejo, Manuel Domínguez-Cajal, José Luis Domínguez Jiménez, Alicia Algaba, Fernando Bermejo, Borislav Vladimirov, László Czakó, Teresa Angueira, Eduardo Iyo, Ekaterina Yuryevna, Larissa Tarasova, Ludmila Grigorieva, Judith Millastre, Aldis Pukitis, Valeriy Kryvy, Roald Torp, Albert Tomàs, Edurne Amorena, Fermin Estremera, Rossen Nikolov, Asghar Quasim, Yury Aleksandrovich Kucheryavyy, Natalia Baryshnikova, Xavier Calvet, Ariadna Figuerola, Marco Romano, Antonietta Gerarda Gravina, Oscar Núñez, Fazia Mana, Pilar Sánchez-Pobre, Zoya Spassova, Jesús M González-Santiago, Ricardo Marcos-Pinto, F Wolfhagen, Svetlana Cui, Ivonne Leeuwenburgh, Driffa Moussata, Adi Lahat-Zok, Sergii Hryhorovych, Rasmus Goll, Tatyana Vasilyevna, Juris Pokrotnieks, Philippe Émile, Nadiya Byelyayeva, Marta Lozano, Mette Wildner-Christensen, Bengt Odman, Yana Valerieva, Alenka Forte, Antonio Cuadrado, Patrice Pienkowski, Ilze Kikuste, Dag Arne Lihaug Hoff, Jane Moeller Hansen, Konrads Funka, Alla Kononova, Sergey Kolbasnikov, Michael Selgrad, Jolanta Sumskiene, Jonathan Hirsch, Francisco Javier Zozaya Larequi, Alain C Burette, Nora Dancs Petz-Aladar, Janne Rajala Herttoniemi, Christina Reimer, Diogo Libanio, Pedro Pimentel-Nunes, Ivailo Evstatiev, Juozas Kupcinskas, Mikhail Butov, Peter Mensink, T Tang, Andrey Yurevich Baranovsky, Natalya Marchenko, Boris Bastens, Lyudmila Mateva, Dominique Lamarque, Leonardo Henry, Mario Ribeiro, M Ter Borg, Alexander C Ford, Enrique Medina, Manuel Rodriguez-Tellez, Francisco José Rancel, Elisa Martin, Carolina Torres Gonzalez, Lissa Maria Franco, Angel Lanas, Pilar Canelles, Noelia Alcaide, Bruno Richard-Molard, Megraud, Francis, Nyssen O.P., Bordin D., Tepes B., Perez-Aisa A., Vaira D., Caldas M., Bujanda L., Castro-Fernandez M., Lerang F., Leja M., Rodrigo L., Rokkas T., Kupcinskas L., Perez-Lasala J., Jonaitis L., Shvets O., Gasbarrini A., Simsek H., Axon A.T.R., Buzas G., Machado J.C., Niv Y., Boyanova L., Goldis A., Lamy V., Tonkic A., Przytulski K., Beglinger C., Venerito M., Bytzer P., Capelle L., Milosavljevic T., Milivojevic V., Veijola L., Molina-Infante J., Vologzhanina L., Fadeenko G., Arino I., Fiorini G., Garre A., Garrido J., F Perez C., Puig I., Heluwaert F., Megraud F., O'Morain C., Gisbert J.P., Universidad Autonoma de Madrid (UAM), University of Bologna, Università cattolica del Sacro Cuore [Roma] (Unicatt), Universidade do Porto, Tel Aviv University [Tel Aviv], Otto-von-Guericke University [Magdeburg] (OVGU), Nyssen, Op, Bordin, D, Tepes, B, Pérez-Aisa, Á, Vaira, D, Caldas, M, Bujanda, L, Castro-Fernandez, M, Lerang, F, Leja, M, Rodrigo, L, Rokkas, T, Kupcinskas, L, Pérez- Lasala, J, Jonaitis, L, Shvets, O, Gasbarrini, A, Simsek, H, Axon, Atr, Buzás, G, Machado, Jc, Niv, Y, Boyanova, L, Goldis, A, Lamy, V, Tonkic, A, Przytulski, K, Beglinger, C, Venerito, M, Bytzer, P, Capelle, L, Milosavljević, T, Milivojevic, V, Veijola, L, Molina-Infante, J, Vologzhanina, L, Fadeenko, G, Ariño, I, Fiorini, G, Garre, A, Garrido, J, F Pérez, C, Puig, I, Heluwaert, F, Megraud, F, O'Morain, C, Gisbert, Jp, and Romano, M

Subjects
Male, Registrie, Proton Pump Inhibitor, Practice Patterns, 0302 clinical medicine, Clarithromycin, Prospective Studies, Registries, Practice Patterns, Physicians', [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, biology, Gastroenterology, Middle Aged, Anti-Bacterial Agents, 3. Good health, Europe, 030220 oncology & carcinogenesis, Combination, 030211 gastroenterology & hepatology, Drug Therapy, Combination, Female, medicine.drug, Human, Adult, medicine.medical_specialty, TRIPLE THERAPY, QUADRUPLE THERAPY, CONSENSUS, INFECTION, METAANALYSIS, CLARITHROMYCIN, GUIDELINES, RESISTANCE, ARTICLE, Settore MED/12 - GASTROENTEROLOGIA, First line, Helicobacter Infections, 03 medical and health sciences, Drug Therapy, Internal medicine, Anti-Bacterial Agent, medicine, Humans, Medical prescription, Adverse effect, Aged, Physicians', Helicobacter pylori, business.industry, helicobacter pylori - treatment, Proton Pump Inhibitors, Amoxicillin, biology.organism_classification, Metronidazole, Prospective Studie, Concomitant, helicobacter pylori, business, Helicobacter Infection, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

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.

Published
2020
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8. Diffuse intestinal ganglioneuromatosis an uncommon manifestation of Cowden syndrome.

Author

Herranz Bachiller MT, Barrio Andrés J, Pons F, Alcaide Suárez N, Ruiz-Zorrilla R, Sancho Del Val L, Lorenzo Pelayo S, De La Serna Higuera C, Atienza Sánchez R, and Perez Miranda M

Abstract

Diffuse intestinal ganglioneuromatosis is a hamartomatous polyposis characterized by a disseminated, intramural or transmural proliferation of neural elements involving the enteric plexuses. It has been associated with MEN II, neurofibromatosis type 1 and hamartomatous polyposis associated with phosphatase and tensin homolog mutation. We report the case of a female patient with a history of a breast and endometrial tumor who presented in a colonoscopy performed for rectal bleeding diffuse ganglioneuromatosis, which oriented the search for other characteristic findings of Cowden syndrome given the personal history of the patient. The presence of an esophagogastric polyposis was also noted. Cowden syndrome is characterized by skin lesions, but it is rarely diagnosed by these lesions, because they are usually overlooked. Intestinal polyposis is not a major diagnostic criterion but it is very useful for early diagnosis. The combination of colonic polyposis and glucogenic acanthosis should orient the diagnosis to Cowden syndrome.

Published
2013
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