Empirical rescue treatment of Helicobacter pylori infection in third and subsequent lines: 8-year experience in 2144 patients from the European Registry on H. pylori management (Hp-EuReg).

OBJECTIVE: To evaluate the use, effectiveness and safety of Helicobacter pylori empirical rescue therapy in third and subsequent treatment lines in Europe. DESIGN: International, prospective, non-interventional registry of the clinical practice of European gastroenterologists. Data were collected and quality reviewed until October 2021 at Asociación Española de Gastroenterología-Research Electronic Data Capture. All cases with three or more empirical eradication attempts were assessed for effectiveness by modified intention-to-treat and per-protocol analysis. RESULTS: Overall, 2144 treatments were included: 1519, 439, 145 and 41 cases from third, fourth, fifth and sixth treatment lines, respectively. Sixty different therapies were used; the 15 most frequently prescribed encompassed >90% of cases. Overall effectiveness remained <90% in all therapies. Optimised treatments achieved a higher eradication rate than non-optimised (78% vs 67%, p<0.0001). From 2017 to 2021, only 44% of treatments other than 10-day single-capsule therapy used high proton-pump inhibitor doses and lasted ≥14 days. Quadruple therapy containing metronidazole, tetracycline and bismuth achieved optimal eradication rates only when prescribed as third-line treatment, either as 10-day single-capsule therapy (87%) or as 14-day traditional therapy with tetracycline hydrochloride (95%). Triple amoxicillin-levofloxacin therapy achieved 90% effectiveness in Eastern Europe only or when optimised. The overall incidence of adverse events was 31%. CONCLUSION: Empirical rescue treatment in third and subsequent lines achieved suboptimal effectiveness in most European regions. Only quadruple bismuth-metronidazole-tetracycline (10-day single-capsule or 14-day traditional scheme) and triple amoxicillin-levofloxacin therapies reached acceptable outcomes in some settings. Compliance with empirical therapy optimisation principles is still poor 5 years after clinical practice guidelines update. TRIAL REGISTRATION NUMBER: NCT02328131.

Acute pancreatitis in SARS-CoV-2 infection. Beyond respiratory distress.

We read with great interest the two letters published in November regarding SARS-CoV-2 infection and acute pancreatitis (AP). We report our only case of AP related to such infection.

Acute pancreatitis related to SARS-CoV-2 infection. Disclaimer.

Regarding our article "Daño pancreático: pancreatitis aguda en pacientes COVID-19", we would like to clarify that the case previously described met the diagnostic criteria for acute pancreatitis, defined in the Atlanta classification and mentioned in several guidelines.

Acute pancreatitis associated with levofloxacin.

According to some series, 0.3-1.5% of all cases of acute pancreatitis are drug induced. Acute pancreatitis due to levofloxacin is included in its safety data sheet as an adverse effect.

A bull horn fragment found on colonoscopy.

An 81-year-old man with mild iron deficiency anemia (Hb 12 g/dl) and a positive fecal occult blood test was referred for a colonoscopy. The patient was asymptomatic and not undergoing any treatment. A foreign body that crossed the colonic lumen and prevented the colonoscope progression was identified at 40 cm from the anal verge via colonoscopy. The object seemed to be hard and fixed when manipulated with biopsy forceps.

Colonic obstruction secondary to Actinomyces.

Actinomycosis is an uncommon granulomatous infection by Gram-positive anaerobic bacteria of the genus Actinomyces. A. israelii is a major human pathogen. The most frequent locations for colonization are cervicofacial (50%), abdominal (20%) and thoracic (15-20%). The abdominal actinomycosis predisposing factors include recent surgery, trauma and neoplasias. Certain cases have been associated with the intrauterine contraception device (IUD).

Obstrucción colónica secundaria a Actinomyces / Colonic obstruction secondary to Actinomyces

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A bull horn fragment found on colonoscopy

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Acute pancreatitis associated with levofloxacin

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