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1. Quinolone resistance mechanisms among third-generation cephalosporin resistant isolates of Enterobacter spp. in a Bulgarian university hospital

Author

Markovska R, Stoeva T, Dimitrova D, Boyanova L, Stankova P, Mihova K, and Mitov I

Subjects
quinolone resistance, Enterobacter spp, PMQR, Bulgaria, Infectious and parasitic diseases, RC109-216
Abstract

Rumyana Markovska,1 Temenuga Stoeva,2 Dobromira Dimitrova,2 Lyudmila Boyanova,1 Petya Stankova,1 Kalina Mihova,3 Ivan Mitov11Department of Medical Microbiology, Medical University of Sofia, Sofia, Bulgaria; 2Department of Microbiology, University Hospital “Saint Marina”, Medical University, Varna, Bulgaria; 3Molecular Medicine Center, Medical University of Sofia, Sofia, BulgariaBackground: There have been no reports in Bulgaria about quinolone resistance determinants among Enterobacter spp.Aims: To investigate plasmid and chromosomal quinolone resistance rates among 175 third-generation cephalosporin resistant Enterobacter spp. isolates (167 Enterobacter cloacae complex and eight Enterobacter aerogenes isolates) collected at a university hospital in Varna, Bulgaria, as well as to reveal their association with ESBL/AmpC production and a carriage of specific plasmid replicon types.Methods: PCR, isoelectric focusing, replicon typing, sequencing, and epidemiology typing were carried out.Results: A high level of combined third-generation cephalosporin and quinolone resistant Enterobacter spp. was found − 79.4%. The ESBL production rate was 87%, consisting mainly of CTX-M-15 among E. cloacae complex (in 76%) and CTX-M-3 among E. aerogenes (in 88%). Plasmid mediated quinolone resistance (PMQR) determinants were identified in 57% of the isolates. The most commonly detected PMQR determinants were qnrB (90%), consisting mainly of qnrB1 (in 61%), and qnrB9 (in 27%) of the isolates. Both alleles were transferred with CTX-M-15 genes; transconjugants showed HI2 replicons (for qnrB1 positive transconjugants) and were non-typeable (for qnrB9). One Enterobacter spp. isolate produced qnrB4. QnrA1, qnrS1, and aac(6ʹ)-Ib-cr were detected in single isolates only. QnrC, qnrD, qepA, and oqxAB genes were not found. QnrB was associated with CTX-M-15 production, and qnrS1 was linked to CTX-M-3. Alterations in 83 and 87 positions of gyrB in quinolone-resistance determining regions, and 80 position of parC were detected in high level quinolone resistant isolates. Among all the Enterobacter spp. isolates tested, one predominant clone A was identified (53%).Conclusion: Our data showed the necessity of more prudent use of quinolones and third-generation cephalosporins, because of the risk of promoting dissemination, and selection of multiple resistance determinants (ESBL, PMQR) among Enterobacter spp. isolates in Bulgaria.Keywords: quinolone resistance, Enterobacter spp., PMQR, Bulgaria

Published
2019

3. 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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4. Empirical Second-Line Therapy in 5,000 Patients of the European Registry on Helicobacter pylori Management (Hp-EuReg)

Author

Nyssen OP, Vaira D, Pérez Aísa Á, Rodrigo L, Castro-Fernandez M, Jonaitis L, Tepes B, Vologzhanina L, Caldas M, Lanas A, Lucendo AJ, Bujanda L, Ortuño J, Barrio J, Huguet JM, Voynovan I, Lasala JP, Sarsenbaeva AS, Fernandez-Salazar L, Molina-Infante J, Jurecic NB, Areia M, Gasbarrini A, Kupcinskas J, Bordin D, Marcos-Pinto R, Lerand F, Leja M, Buzas GM, Niv Y, Rokkas T, Phull P, Smith S, Shvets O, Venerito M, Milivojevic V, Simsek I, Lamy V, Bytzer P, Boyanova L, Kunovský L, Beglinger C, Doulberis M, Marlicz W, Goldis A, Tonkic A, Capelle L, Puig I, Megraud F, Morain CO, Gisbert JP, and European Registry on Helicobacter pylori Management Hp-EuReg Investigators

Subjects
Helicobacter pylori, Clarithromycin, Rescue, Levofloxacin, Bismuth
Abstract

BACKGROUND & AIMS: After a first Helicobacter pylori eradication attempt, approximately 20% of patients will remain infected. The aim of the current study was to assess the effectiveness and safety of second-line empiric treatment in Europe. METHODS: This international, multicenter, prospective, noninterventional registry aimed to evaluate the decisions and outcomes of H pylori management by European gastroenterologists. All infected adult cases with a previous eradication treatment attempt were registered with the Spanish Association of Gastroenterology-Research Electronic Data Capture until February 2021. Patients allergic to penicillin and those who received susceptibility-guided therapy were excluded. Data monitoring was performed to ensure data quality. RESULTS: Overall, 5055 patients received empiric second-line treatment. Triple therapy with amoxicillin and levofloxacin was prescribed most commonly (33%). The overall effectiveness was 82% by modified intention-to-treat analysis and 83% in the per-protocol population. After failure of first-line clarithromycin-containing treatment, optimal eradication (>90%) was obtained with moxifloxacin-containing triple therapy or levofloxacin-containing quadruple therapy (with bismuth). In patients receiving triple therapy containing levofloxacin or moxifloxacin, and levofloxacin-bismuth quadruple treatment, cure rates were optimized with 14-day regimens using high doses of proton pump inhibitors. However, 3-in-1 single capsule or levofloxacin-bismuth quadruple therapy produced reliable eradication rates regardless of proton pump inhibitor dose, duration of therapy, or previous first-line treatment. The overall incidence of adverse events was 28%, and most (85%) were mild. Three patients developed serious adverse events (0.3%) requiring hospitalization. CONCLUSIONS: Empiric second-line regimens including 14-day quinolone triple therapies, 14-day levofloxacin-bismuth quadruple therapy, 14-day tetracycline-bismuth classic quadruple therapy, and 10-day bismuth quadruple therapy (as a single capsule) provided optimal effectiveness. However, many other second-line treatments evaluated reported low eradication rates. ClincialTrials.gov number: NCT02328131.

Published
2022

5. Empirical first-line treatment use and effectiveness trends in Europe in the period 2013- 2020: results from the European registry on H. pylori management (HP-EUREG)

Author

O. P. Nyssen , Á. Pérez-Aísa , D. Vaira , L. Jonaitis , B. Tepes , A. Keco-Huerga , M. Castro- Fernández , A. Lucendo , D. Bordin , N. Brglez Jurecic , L. Vologzhanina, M. Caldas , G. Fadieienko, R. Abdulkhakov, L. Bujanda, M. Leja, M. Romano, S. Georgopoulos, Ante Tonkić, H. Simsek, A. Gasbarrini, G. M Buzas, P. Phull, M. Venerito, P. Malfertheiner, J. Kupčinskas , G. Babayeva, O. Shvets, F. Lerang, R. Marcos Pinto, T. Rokkas, I. Simsek, S. Smith, Y. Niv, D. Lamarque, F. Heluwaert, A. Goldis, W. Marlicz, V. Milivojevic, L. Boyanova, L. Kunovský, V. Lamy, C. Beglinger, P. Bytzer, L. Capelle, I. Puig, F. Mégraud, C. O’Morain, J. P. Gisbert

Subjects
Helicobacter pylori
Abstract

Background: The impact of consensus, prescription choices and efficacy trends on clinical practice over time has not been studied in depth. Methods: International multicenter prospective non-interventional registry aimed to evaluate the decisions and outcomes of H. pylori management by European gastroenterologists. All infected adult patients were registered at AEG-REDCap e-CRF up to February 2021. Modified intention-to-treat (mITT) and time trend analyses were performed. Results: So far 29, 634 first-line empirical prescriptions from 31 European countries have been included. Overall, the most common prescribed treatments in the 2013-20 were triple therapies ; however, a shift in antibiotic regimens was identified. Triple therapies decreased from over 50% of prescription in 2013/15 to less than 20% in 2018/20. Non- bismuth concomitant therapy use decreased from 21% in 2013/14 to 13% in 2019/20, while Pylera® increased from 0-1% in 2014/2015 to 19% in 2019/20. An increase in the average duration of treatments from 11 to 13 days in 2013-2020, and of the daily dose of PPI, was identified (No trend was identified (data now shown) ; however, there was an 8% overall improvement in first-line mITT overall effectiveness from 2013 to 2020 (Table 1). Conclusions: European gastroenterological practice is constantly adapting to the newest published evidence and recommendations (reducing the use of triple therapies and increasing the duration of treatment and the dose of PPIs), with a subsequent progressive improvement in overall effectiveness.

Published
2021

6. First-line empirical H. pylori eradication therapy in Europe: results from 30,000 cases of the European registry on H. pylori management (HP- EUREG)

Author

O. P. Nyssen, Á. Pérez-Aísa, D. Vaira, L. Jonaitis, B. Tepeš, A. Keco-Huerga, M. Castro Fernández, A. Lucendo, D. Bordin, N. Brglez Jurecic, L. Vologzhanina, M. Caldas, G. Fadieienko, R. Abdulkhakov, L. Bujanda, M. Leja, M. Romano, S. Georgopoulos, V. Ntouli, Ante Tonkić, H. Simsek, A. Gasbarrini, G. M Buzas, P. Phull, M. Venerito, P. Malfertheiner, J. Kupčinskas, G. Babayeva, O. Shvets, F. Lerang, R. Marcos Pinto, T. Rokkas, I. Ilkay Simsek, S. Smith, Y. Niv, D. Lamarque, F. Heluwaert, A. Goldis, W. Marlicz, V. Milivojevic, L. Boyanova, L. Kunovský, V. Lamy, C. Beglinger, P. Bytzer, L. Capelle, I. Puig, F. Mégraud, C. O’Morain, J. P. Gisbert

Subjects
Helicobacter pylori, eradication therapy
Abstract

Introduction: The best approach for Helicobacter pylori management re-mains unclear. An audit process is essential to ensure clinical practice is aligned with best standards of care.Aims & Methods: International multicentre prospective non-intervention-al 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 February 2021. Variables in-cluded: demographics, previous eradication attempts, prescribed treat-ment, 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 41, 562 patients from 31 European countries were evaluat-ed and 29, 634 (70%) first-line empirical H. pylori treatments were included for analysis. Triple therapy with amoxicillin and clarithromycin was most commonly prescribed (39%), followed by non-bismuth concomitant treat-ment (18%) and bismuth quadruple (three-in-one single capsule) (12%), achieving 84%, 90% and 94% mITT eradication rate, respectively. Over 90% effectiveness was obtained only with 10 and 14-day bismuth quadru- ple or with 14-day concomitant treatment (Table). Longer treatment dura-tion, higher acid inhibition and compliance were associated with higher eradication rates. Conclusion: Management of H. pylori infection by European gastroenter-ologists is heterogeneous. Only quadruple therapies lasting at least ten days are able to achieve over 90% eradication rates.

Published
2021

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, 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, Antonio, 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., Gasbarrini A. (ORCID:0000-0002-7278-4823), 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, Antonio, 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., and Gasbarrini A. (ORCID:0000-0002-7278-4823)

Abstract

Objective 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. 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. Results 30 394 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%). Conclusion Management 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
2021

9. Impact of Helicobacter pylori clarithromycin resistance on the treatment effectiveness: data of the European registry on H. pylori management (HP- EUREG)

Author

Bujanda L., Nyssen O.P., Cosme A., Bordin D.S., Tepeš B., Pere-Aisa A., Vaira D., Caldas Álvarez M., 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.M., Machado J.C., Niv Y., Boyanova L., Goldis A., Lamy V., Tonkić Ante, Marlicz W., Beglinger C., Venerito M., Bytzer P., Capelle L.G., Milosavljevic T., Veijola L.I., Molina Infante J., Vologhzanina L., Fadeenko G., Ariño I., Fiorini G., Resina E., Muñoz R., Puig I., Megraud F., O’ Morain C., Gisbert J.P.

Subjects
Helicobacter pylori, clarithromycin, resistance
Abstract

Introduction: Antibiotic resistance is the major factor affecting our ability to cure Helicobacter pylori infection. Quadruple therapy is currently recommended ; however, triple therapy with two antibiotics may be sufficient in those patients without clarithromycin resistance. Aims & Methods: To evaluate the effectiveness of the treatments according to the clarithromycin H. pylori resistance in Europe. International multicenter prospective non-interventional European Registry on H. pylori Management (Hp-EuReg) aiming to evaluate the decisions and outcomes of H. pylori infection. Infected adult patients diagnosed with culture registered at AEG-REDCap e- CRF from 2013 to 2019. Per-protocol (PP) analysis was performed based on the presence or absence of clarithromycin bacterial resistance. Results: Overall, 5, 036 patients were included: 1, 747 (35%) were resistant and 3, 289 (65%) sensitive to clarithromycin. The overall eradication rate was higher in clarithromycin-susceptible patients (91% vs. 84% ; p< 0.001). Triple therapy with a PPI, clarithromycin and amoxicillin achieved over 90% eradication rates in clarithromycin- susceptible patients. However, in those with clarithromycin- resistance, optimal effectiveness was only achieved when treated with quadruple therapy with a PPI, clarithromycin, amoxicillin and bismuth. Conclusion: Classic triple therapy with a PPI, clarithromycin and amoxicillin achieves optimal results (>90%) in patients susceptible to clarithromycin. However, when clarithromycin resistance is unknown, quadruple therapy with a PPI, clarithromycin, amoxicillin and bismuth may be a better treatment option.

Published
2020

10. Helicobacter pylori antibiotic resistance: data from the European registry on H. pylori management (HP-EUREG)

Author

Bujanda L., Nyssen O.P., Cosme A., Bordin D.S., Tepeš B., Pere-Aisa A., Vaira D., Caldas Álvarez M., 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.M., Machado J.C., Niv Y., Boyanova L., Goldis A., Lamy V., Tonkić Ante, Marlicz W., Beglinger C., Venerito M., Bytzer P., Capelle L.G., Milosavljevic T., Veijola L.I., Molina Infante J., Vologhzanina L., Fadeenko G., Ariño I., Fiorini G., Resina E., Muñoz R., Puig I., Megraud F., O’ Morain C., Gisbert J.P.

Subjects
Helicobacter pylori, antibiotic resistance
Abstract

Introduction: Antibiotic resistance is the major factor affecting our ability to cure Helicobacter pylori infection. Understanding the different H. pylori antibiotic resistances could be the key to improve treatment effectiveness. Aims & Methods: To evaluate the H. pylori antibiotic resistance both prior and after one or several eradication treatments, in order to provide the most appropriate recommendations for the eradication of H. pylori. International multicenter prospective non-interventional European Regis-try on H. pylori Management (Hp- EuReg) aiming to evaluate the decisions and outcomes of H. pylori infection by European gastroenterologists. Infected adult patients diagnosed with culture and with a result of the antibiotic resistance test registered at AEG- REDCap e-CRF from 2013 to 2019. Per-protocol (PP) analysis was performed. The antibiotic bacterial resistances were described by treatment line. Results: A total of 32, 447 patients were included, and culture was performed in 3, 474 (11%). In naïve patients, 21% reported single clarithromycin resistance, and 11% dual (clarithromycin and metronidazole) resistance. Antibiotic resistance increased markedly from the first treatment, reaching over 37% dual resistance in second-line treatment. Conclusion: In Europe, culture testing to determine antibiotic resistance against H. pylori is scarce. H. pylori single clarithromycin resistance remains high (>15%) in all treatment lines, and greater than 20% in naïve patients. Dual or triple resistances are frequent and increase remarkably after the first treatment failure. Resistance to amoxicillin or tetracycline is exceptional.

Published
2020

11. Antibiotic resistance trends of Helicobacter pylori naïve patients in the period 2013-2019: analysis of the European registry on H. pylori management (HP-EUREG)

Author

Bujanda L., Nyssen O.P., Cosme A., Bordin D.S., Tepeš B., Pere-Aisa A., Vaira D., Caldas Álvarez M., 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.M., Machado J.C., Niv Y., Boyanova L., Goldis A., Lamy V., Tonkić Ante, Marlicz W., Beglinger C., Venerito M., Bytzer P., Capelle L.G., Milosavljevic T., Veijola L.I., Molina Infante J., Vologhzanina L., Fadeenko G., Ariño I., Fiorini G., Resinas E., Muñoz R., Puig I., Megraud F., O’ Morain C., Gisbert J.P.

Subjects
Helicobacter pylori, antibiotic resistance
Abstract

Introduction: Bacterial antibiotic resistance changes over time based on multiple factors. It is essential to study these trends to apply preventive strategies to help reducing such resistances.Aims & Methods: To conduct a time-trend analysis of the antibiotic resistance to H. pylori infection in the European Registry on H. pylori (Hp-EuReg). International multicenter prospective non- interventional European Registry on H. pylori Management (Hp-EuReg) aiming to evaluate the decisions and outcomes of H. pylori infection by European gastroenterologists. All infected adult patients diagnosed with culture and with a result of the antibiotic resistance test were registered at AEG-REDCap e-CRF from 2013 to 2019.Results: A total of 32, 447 patients were included, and culture was performed in 3, 474 (11%), where 2, 483 näive patients were included for analysis. Resistance to at least one antibiotic was described in 57% of the patients. Resistance to metronidazole (27%) was most frequent, whereas resistance to tetracycline and amoxicillin was below 1%. Clarithromycin resistance remained above 15% throughout the studied years. A significant decrease in the metronidazole resistance rate was observed between 2013 (38%) and 2018 (21%).Conclusion: In naïve patients, resistance to clarithromycin remained above 15% in the period 2013-2019. A progressive decrease in metronidazole resistance was observed. No increasing or decreasing trend was observed in the bacterial resistance to other antibiotics.

Published
2020

12. Helicobacter pylori first-line and rescue treatments in patients allergic to penicillin: Experience from the European Registry on H pylori management (Hp-EuReg)

Author

Nyssen, O. P., Perez-Aisa, A., Tepes, B., Rodrigo-Saez, L., Romero, P. M., Lucendo, A., Castro-Fernandez, M., Phull, P., Barrio, J., Bujanda, L., Ortuno, J., Areia, M., Brglez Jurecic, N., Huguet, J. M., Alcaide, N., Voynovan, I., Maria Botargues Bote, J., Modolell, I., Perez Lasala, J., Arino, I., Jonaitis, L., Dominguez-Cajal, M., Buzas, G., Lerang, F., Perona, M., Bordin, D., Axon, T., Gasbarrini, Antonio, Marcos Pinto, R., Niv, Y., Kupcinskas, L., Tonkic, A., Leja, M., Rokkas, T., Boyanova, L., Shvets, O., Venerito, M., Bytzer, P., Goldis, A., Simsek, I., Lamy, V., Przytulski, K., Kunovsky, L., Capelle, L., Milosavljevic, T., Caldas, M., Garre, A., Megraud, F., O'Morain, C., Gisbert, J. P., Hinojosa, J., Fernandez, N., Molina Infante, J., Alonso Galan, H., Di Maira, T., Alves, S. I., Saraiva, S., Elvas, L., Brito, D., Teresa Cadime, A., Lampic, P., Gruncic, A., Leban, V., Ferrer, L., Fernandez Salazar, L., Lanas, A., Kristensen, V., Brackmann, S., Delchier, J. C., Anton, C., Gomez Rodriguez, B. J., Pellicano, R., Boltin, D., and Gastroenterology & Hepatology

Subjects
medicine.medical_specialty, Allergy, Settore MED/12 - GASTROENTEROLOGIA, allergic, Penicillins, Gastroenterology, Helicobacter Infections, Drug Hypersensitivity, 03 medical and health sciences, 0302 clinical medicine, Levofloxacin, Metronidazole, Clarithromycin, Internal medicine, bismuth, medicine, Humans, Prospective Studies, Registries, Adverse effect, levofloxacin, biology, Helicobacter pylori, business.industry, Settore MED/09 - MEDICINA INTERNA, allergy, clarithromycin, penicillin, Proton Pump Inhibitors, General Medicine, Tetracycline, biology.organism_classification, medicine.disease, Anti-Bacterial Agents, 3. Good health, Penicillin, Regimen, Infectious Diseases, 030220 oncology & carcinogenesis, Drug Therapy, Combination, 030211 gastroenterology & hepatology, business, medicine.drug
Abstract

Background Experience in Helicobacter pylori eradication treatment of patients allergic to penicillin is very scarce. A triple combination with a PPI, clarithromycin (C), and metronidazole (M) is often prescribed as the first option, although more recently the use of a quadruple therapy with PPI, bismuth (B), tetracycline (T), and M has been recommended. Aim To evaluate the efficacy and safety of first-line and rescue treatments in patients allergic to penicillin in the "European Registry of H pylori management" (Hp-EuReg). Methods A systematic prospective registry of the clinical practice of European gastroenterologists (27 countries, 300 investigators) on the management of H pylori infection. An e-CRF was created on AEG-REDCap. Patients with penicillin allergy were analyzed until June 2019. Results One-thousand eighty-four patients allergic to penicillin were analyzed. The most frequently prescribed first-line treatments were as follows: PPI + C + M (n = 285) and PPI + B + T + M (classic or Pylera(R); n = 250). In first line, the efficacy of PPI + C + M was 69%, while PPI + B + T + M reached 91% (P < .001). In second line, after the failure of PPI + C + M, two rescue options showed similar efficacy: PPI + B + T + M (78%) and PPI + C + levofloxacin (L) (71%) (P > .05). In third line, after the failure of PPI + C + M and PPI + C + L, PPI + B + T + M was successful in 75% of cases. Conclusion In patients allergic to penicillin, a triple combination with PPI + C + M should not be generally recommended as a first-line treatment, while a quadruple regimen with PPI + B + T + M seems to be a better option. As a rescue treatment, this quadruple regimen (if not previously prescribed) or a triple regimen with PPI + C + L could be used but achieved suboptimal (

Published
2020

13. First line H. pylori eradication therapy in Europe: results from 24,882 cases of the European registry on H. pylori management (HP-EUREG)

Author

Nyssen O.P., Bordin D.S., Tepeš B., Perez Aisa M.Á., Caldas Álvarez M., Bujanda Fernández de Piérola L., Pabon Carrasco M., Castro Fernandez M., Lerang F., Leja M., Rokkas T., Kupcinskas L., Jonaitis L., Shvets O., Gasbarrini A., Axon A., Şimşek H., Buzás G.M., Machado J.C.L., Niv Y., Boyanova L., Rodrigo L., Perez-Lasala J., Goldis E.-A., Lamy V., Tonkić Ante, Przytulski K., Beglinger C., Venerito M., Bytzer P., Capelle L., Milivojević V., Veijola L., Molina Infante J., Vologzhanina L., Dino V., Fadeenko G., Ariño Pérez I., Fiorini G., Garre A., Keko-Huerga A., Heluwaert F., Garrido J., Fernandez Perez C., Puig I., Megraud F., O’Morain C., Gisbert J.P.

Subjects
Helicobacter pylori, eradication therapy
Abstract

Introduction: 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.Aims & Methods: 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 attempts, 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 (Table). Longer treatment duration, higher acid inhibition and compliance were associated with higher eradication rates.Conclusion: Management of H. pylori infection by European gastroenterologists is heterogeneous. Only quadruple therapies lasting at least ten days are able to achieve over 90% eradication rates.

Published
2020

23. PAN-EUROPEAN REGISTRY ON H. PYLORI MANAGEMENT (HP-EUREG): RESCUE TREATMENTS

Author

Axon, T., Lamy, V., Gisbert, J. P., McNicholl, A. G., Gasbarrini, A., Katicic, M., Machado, J. C., Boyanova, L., Przytulski, K., Simsek, I., Buzas, G. M., Tepes, B., Lerang, F., Bordin, D. S., Shvets, O., Beglinger, C., Capelle, L. G., Bytzer, P., Goldis, A., Rokkas, T., Kupcinskas, L., Ramas, M., O'Morain, C. A., Megraud, F., Caldas, M., Veijola, L., and Leja, M.

Published
2014

24. PAN-EUROPEAN REGISTRY ON H. PYLORI MANAGEMENT (HP-EUREG): SAFETY

Author

Katicic, M., Lamy, V., Axon, T., Gisbert, J. P., O'Morain, C. A., Megraud, F., Ramas, M., Caldas, M., Veijola, L., Capelle, L. G., Goldis, A., Bytzer, P., Beglinger, C., Buzas, G. M., Simsek, I., Przytulski, K., Boyanova, L., McNicholl, A. G., Gasbarrini, A., Tepes, B., Lerang, F., Bordin, D. S., Shvets, O., Rokkas, T., Kupcinskas, L., Leja, M., and Machado, J. C.

Published
2014

25. PAN-EUROPEAN REGISTRY ON H. PYLORI MANAGEMENT (HP-EUREG): INTERIM ANALYSIS OF 5792 PATIENTS

Author

Bordin, D. S., Lerang, F., McNicholl, A. G., Gasbarrini, A., Tepes, B., Rokkas, T., Buzas, G. M., Simsek, I., Przytulski, K., Boyanova, L., Machado, J. C., Katicic, M., Leja, M., Kupcinskas, L., Shvets, O., Axon, T., Gisbert, J. P., O'Morain, C. A., Megraud, F., Ramas, M., Caldas, M., Veijola, L., Cappelle, L. G., Goldis, A., Lamy, V., Bytzer, P., and Beglinger, C.

Published
2014

26. PAN-EUROPEAN REGISTRY ON H. PYLORI MANAGEMENT (HP-EUREG): FIRST-LINE TREATMENTS

Author

Shvets, O., Axon, T., Gisbert, J. P., O'Morain, C. A., Megraud, F., Ramas, M., Caldas, M., Veijola, L., Cappelle, L. G., Goldis, A., Lamy, V., Bytzer, P., Beglinger, C., Buzas, G. M., Simsek, I., Przytulski, K., Boyanova, L., Machado, J. C., Katicic, M., Leja, M., Kupcinskas, L., Rokkas, T., Bordin, D. S., Lerang, F., Tepes, B., Gasbarrini, A., and McNicholl, A. G.

Published
2014

27. The status of antimicrobial resistance of Helicobacter pylori in eastern Europe

Author

Boyanova, L Mentis, A Gubina, M Rozynek, E Gosciniak, G and Kalenic, S Goral, V Kupcinskas, L Kantarceken, B and Aydin, A Archimandritis, A Dzierzanowska, D Vcev, A and Ivanova, K Marina, M Mitov, I Petrov, P Ozden, A and Popova, M

Abstract

Objective To evaluate the primary, secondary and combined resistance to five antimicrobial agents of 2340 Helicobacter pylori isolates from 19 centers in 10 countries in eastern Europe. Methods Data were available for centers in Bulgaria, Croatia, the Czech Republic, Estonia, Greece, Lithuania, Poland, Russia, Slovenia and Turkey. Susceptibility was tested by agar dilution (seven countries), E test (five countries) and disk diffusion (three countries) methods. Resistance breakpoints (mg/L) were: metronidazole 8, clarithromycin 1, amoxicillin 0.5, tetracycline 4, and ciprofloxacin 1 or 4 in most centers. Primary and post-treatment resistance was assessed in 2003 and 337 isolates respectively. Results for 282 children and 201 adults were compared. Results Primary resistance rates since 1998 were: metronidazole 37.9%, clarithromycin 9.5%, amoxicillin 0.9%, tetracycline 1.9%, ciprofloxacin 3.9%, and both metronidazole and clarithromycin 6.1%. Isolates from centers in Slovenia and Lithuania exhibited low resistance rates. Since 1998, amoxicillin resistance has been detected in the southeastern region. From 1996, metronidazole resistance increased significantly from 30.5% to 36.4%, while clarithromycin resistance increased slightly from 8.9% to 10.6%. In centers in Greece, Poland, and Bulgaria, the mean metronidazole resistance was slightly higher in adults than in children (39% versus 31.2%, P > 0.05); this trend was not found for clarithromycin or amoxicillin (P > 0.20). Post-treatment resistance rates exhibited wide variations. Conclusions In eastern Europe, primary H. pylori resistance to metronidazole is considerable, and that to clarithromycin is similar to or slightly higher than that in western Europe. Resistance to amoxicillin, ciprofloxacin and tetracycline was detected in several centers. Primary and post-treatment resistance rates vary greatly between centers.

Published
2002

39. Bactericidal effect of amoxicillin on Helicobacter pylori in an in vitro model using epithelial cells

Author

Megraud, F, pascale, Trimoulet, Lamouliatte, H, and Boyanova, L

Abstract

The treatment of Helicobacter pylori with antimicrobial agents has largely been ineffective, and susceptibility results are in disagreement with those obtained by standard in vitro testing. The bactericidal effect of amoxicillin was tested in an in vitro model by using sessile bacteria attached to HEp-2 cells; this bactericidal effect was compared with that against planktonic bacteria. Viable cell counts were performed by standard procedures after 1, 6, and 24 h of contact with the antibiotic at different concentrations. A bactericidal effect (99.9% killing) was observed against sessile bacteria after 24 h with concentrations of only 10, 1, and 0.1 mg/liter, while against planktonic bacteria it was also noted at concentrations of 0.01 and 0.001 mg/liter, and the effect was observed after 6 h with the three highest concentrations. When the results for five strains were studied by analysis of variance at 6 and 24 h, the main variable was the antibiotic concentration, followed by the culture conditions, e.g., planktonic or sessile bacteria, the strain tested, and the time of contact. A decreased pH of 5.4 did not affect the action of amoxicillin. The bactericidal effect of the combination of amoxicillin and metronidazole was additive against sessile H. pylori.

Published
1991
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43. Pan-European Registry on H. pylori management (Hp-EuReg): bacterial resistance of 2684 H. pylori isolates

Author

Mcnicholl, A. G., Nyssen, O. P., Bordin, D., Tepes, B., Perez-Aisa, A., Vaira, D., Luis Bujanda, Castro-Fernandez, M., Lerang, F., Leja, M., Rodrigo, L., Rokkas, T., Jonaitis, L. V., Perez-Lasala, J., Shvets, O., Gasbarrini, A., Simsek, H., Axon, A., Buzas, G. M., Machado, J. C., Niv, Y., Boyanova, L., Goldis, A., Lamy, V., Katicic, M., Przytulski, K., Venerito, M., Bytzer, P., Milosavljevic, T., Fiorini, G., Donday, M. G., Arino, I., Veijola, L. I., Molina-Infante, J., Megraud, F., O Morain, C., and Gisbert, J. P.

44. Pan-European Registry on H. pylori management (Hp-EuReg): Impact of resistance on efficacy

Author

Mcnicholl, A. G., Nyssen, O. P., Bordin, D. S., Tepes, B., Perez-Aisa, A., Vaira, D., Caldas, M., Bujanda, L., Castro-Fernandez, M., Lerang, F., Leja, M., Luis Rodrigo, Rokkas, T., Jonaitis, L. V., Perez-Lasala, J., Shvets, O., Gasbarrini, A., Simsek, H., Axon, A., Buzas, G. M., Machado, J. C., Niv, Y., Boyanova, L., Goldis, A., Lamy, V., Katicic, M., Przytulski, K., Venerito, M., Bytzer, P., Milosavljevic, T., Fiorini, G., Donday, M. G., Arino, I., Capelle, L. G., Veijola, L. I., Molina-Infante, J., Vologhzanina, L., Fadeenko, G., O Morain, C., Megraud, F., and Gisbert, J. P.

48. PAN-EUROPEAN REGISTRY ON H-PYLORI MANAGEMENT (HP-EUREG): FIRST-LINE TREATMENTS AND INTERIM ANALYSIS OF 11 272 PATIENTS

Author

Mcnicholl, A. G., Gasbarrini, A., Tepes, B., Bordin, D. S., Lerang, F., Leja, M., Rokkas, T., Vaira, D., Shvets, O., Kupcinskas, L., Perez-Aisa, A., Axon, T., Buzas, G. M., Castro, M., Simsek, I., Katicic, M., Machado, J. C., Lamy, V., Przytulski, K., Rodrigo, L., Boyanova, L., Bytzer, P., Beglinger, C., Cappelle, L. G., Goldis, A., Veijola, L., Vujasinovic, M., Luis Bujanda, Molina-Infante, J., Caldas, M., Ramas, M., Donday, M. G., Megraud, F., O Morain, C., and Gisbert, J. P.

49. Pan-European Registry on H. pylori management (Hp-EuReg): interim analysis of 16 600 first-line treatments

Author

Mcnicholl, A. G., Nyssen, O. P., Bordin, D. S., Tepes, B., Perez-Aisa, A., Vaira, D., Caldas, M., Bujanda, L., Castro-Fernandez, M., Lerang, F., Leja, M., Luis Rodrigo, Rokkas, T., Jonaitis, L. V., Perez-Lasala, J., Shvets, O., Gasbarrini, A., Simsek, H., Axon, A., Buzas, G. M., Machado, J. C., Niv, Y., Boyanova, L., Goldis, A., Lamy, V., Katicic, M., Przytulski, K., Venerito, M., Bytzer, P., Milosavljevic, T., Fiorini, G., Donday, M. G., Arino, I., Capelle, L. G., Veijola, L. I., Molina-Infante, J., Vologhzanina, L., Fadeenko, G., Ramas, M., Megraud, F., O Morain, C., and Gisbert, J. P.

50. Pan-European Registry on H. pylori management (Hp-EuReg): analysis of 3532 second-line treatments

Author

Nyssen, O. P., Mcnicholl, A. G., Vaira, D., Perez-Aisa, A., Caldas, M., Tepes, B., Bordin, D., Bujanda, L., Castro-Fernandez, M., Lerang, F., Leja, M., Luis Rodrigo, Rokkas, T., Jonaitis, L. V., Perez-Lasala, J., Shvets, O., Gasbarrini, A., Simsek, H., Axon, A., Buzas, G., Machado, J. C., Niv, Y., Boyanova, L., Goldis, A., Lamy, V., Katicic, M., Przytulski, K., Venerito, M., Bytzer, P., Milosavljevic, T., Fiorini, G., Donday, M. G., Arino, I., Capelle, L. G., Veijola, L. I., Molina-Infante, J., Vologhzanina, L., Ramas, M., O Morain, C., Megraud, F., and Gisbert, J. P.

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