Empirical Second-Line Therapy in 5000 Patients of the European Registry on Helicobacter pylori Management (Hp-EuReg).

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, non-interventional 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.

Effect of three bowel preparations on video-capsule endoscopy gastric and small-bowel transit time and completeness of the examination.

OBJECTIVE: Video capsule endoscopy fails to visualize the caecum in about 20% of patients. The aim of this study was to investigate the effect of different bowel preparations on video capsule endoscopy gastric- (GTT) and small-bowel transit time (SBTT) and the rate of caecal visualization. MATERIAL AND METHODS: We retrospectively examined 186 consecutive capsule endoscopy videos undertaken over a 3-year period, excluding cases with diabetes mellitus or gastric surgery (n=28), cases with unknown bowel preparation and those with unreadable data CDs (n=27). Sixty-seven (36%) patients were prepared with a liquid diet (CL), 54 (29%) with sodium phosphate (PS) and 65 (35%) with polyethylene glycol (PEG). Two independent, experienced investigators examined the videos. RESULTS: No difference was found in GTT among CL, PS and PEG preparations (25, 6.7-116.2 min, 34.75, 4.1-125 min, 35, 6.1-128.6 min, respectively, p=0.29). The caecum was visualized in 56/67 (83.6%), 44/54 (81.5%) and 53/65 (81.5%) patients who received CL, PS and PEG, respectively (p=0.9). In the cases where capsule endoscopy reached the caecum, no difference was observed in SBTT among patients that received CL, PS and PEG (264.4+/-85.9 min, 296.7+/-79.5 min, 291.3+/-84 min, respectively, p=0.11). CONCLUSIONS: Bowel preparations for capsule endoscopy do not have a significant effect on gastric and small-bowel video capsule transit time and the rate of caecum visualization.