Current trends in the management of Helicobacter pylori infection in Serbia: preliminary results from the European registry on H. pylori management (Hp-EuReg)

Background: Helicobacter pylori (H. pylori) is the most common chronic bacterial
infection. Treatment effectiveness remains a subject of debate considering bacterial antimicrobial resistance. Our aim was to analyse the diagnostic methods and eradication treatments for H. pylori infection in Serbia.
Methods: An observational multicentre prospective study was conducted in Serbia, as part of the European Registry on H. pylori Management (Hp-EuReg). Demographics, treatment indication, diagnostic methods, previous eradication attempts and treatment were collected at AEG-REDCap e-CRF. Modified intention-to-treat (mITT) and per protocol (PP) effectiveness analyses were performed. Safety, compliance and bacterial antimicrobial resistance rates were reported. Data was quality checked.
Results: Overall 283 patients were included, with a mean age of 55±15 years. Dyspepsia (n=214, 77%) was the most frequent treatment indication, and histology
(n=144, 51%) was the most used diagnostic method. Overall eradication rate was
95% (PP) and 94% (mITT). Most prevalent first-line therapy was quadruple
PPI+clarithromycin+amoxicillin+metronidazole, with a 96% effectiveness (p<0.001).
Second-line main treatment choice was triple-amoxicillin+levofloxacin, with a 95%
effectiveness (p<0.05). Single-capsule Pylera ® was the most prescribed third-line
therapy, with 100% effectiveness (p<0.05). Longer treatment duration was associated with a higher eradication rate in first-line therapy (p<0.05). Clarithromycin and quinolone resistance rates in first-line were 24% and 8.3%, respectively. The overall adverse events' incidence rate was 13.4%, and therapy compliance was 97%.
Conclusions: Considering the high eradication rate, 14-day non-bismuth quadruple concomitant therapy is a reasonable first-line choice, while quinolone-based therapy
and single-capsule Pylera ® should be considered as rescue therapy options.
