Role of compliance in Helicobacter pylori eradication treatment: Results of the European Registry on H. pylori management.

BACKGROUND: Adherence to Helicobacter pylori (H. pylori) eradication treatment is a cornerstone for achieving adequate treatment efficacy. OBJECTIVE: To determine which factors influence compliance with treatment. METHODS: A systematic prospective non-interventional registry (Hp-EuReg) of the clinical practice of European gastroenterologists. Compliance was considered adequate if ≥90% drug intake. Data were collected until September 2021 using the AEG-REDCap e-CRF and were subjected to quality control. Modified intention-to-treat analyses were performed. Multivariate analysis carried out the factors associated with the effectiveness of treatment and compliance. RESULTS: Compliance was inadequate in 646 (1.7%) of 38,698 patients. The non-compliance rate was higher in patients prescribed longer regimens (10-, 14-days) and rescue treatments, patients with uninvestigated dyspepsia/functional dyspepsia, and patients reporting adverse effects. Prevalence of non-adherence was lower for first-line treatment than for rescue treatment (1.5% vs. 2.2%; p < 0.001). Differences in non-adherence in the three most frequent first-line treatments were shown: 1.1% with proton pump inhibitor + clarithromycin + amoxicillin; 2.3% with proton pump inhibitor clarithromycin amoxicillin metronidazole; and 1.8% with bismuth quadruple therapy. These treatments were significantly more effective in compliant than in non-compliant patients: 86% versus 44%, 90% versus 71%, and 93% versus 64%, respectively (p < 0.001). In the multivariate analysis, the variable most significantly associated with higher effectiveness was adequate compliance (odds ratio, 6.3 [95%CI, 5.2-7.7]; p < 0.001). CONCLUSIONS: Compliance with Helicobacter pylori eradication treatment is very good. Factors associated with poor compliance include uninvestigated/functional dyspepsia, rescue-treatment, prolonged treatment regimens, the presence of adverse events, and the use of non-bismuth sequential and concomitant treatment. Adequate treatment compliance was the variable most closely associated with successful eradication.

Comparison of the management of Helicobacter pylori infection between the older and younger European populations.

The prevalence of Helicobacter pylori remains high in the older population. Specific age-related peculiarities may impact the outcomes of H. pylori treatment. The aim of the study was to evaluate the diagnostics and effectiveness of H. pylori eradication between the younger and older European populations. "European Registry on H. pylori Management (Hp-EuReg)" data from 2013 to 2022 were analyzed. Patients were divided into older (≥ 60 years) and younger (18-59 years) groups. Modified intention-to-treat (mITT) and per-protocol (PP) analysis was performed. 49,461 patients included of which 14,467 (29%) were older-aged. Concomitant medications and penicillin allergy were more frequent among the older patients. Differences between younger and older populations were observed in treatment duration in first-line treatment and in proton pump inhibitors (PPIs) doses in second-line treatment. The overall incidence of adverse events was lower in the older adults group. The overall first-line treatment mITT effectiveness was 88% in younger and 90% in the older patients (p < 0.05). The overall second-line mITT treatment effectiveness was 84% in both groups. The effectiveness of the most frequent first- and second-line triple therapies was suboptimal (< 90%) in both groups. Optimal efficacy (≥ 90%) was achieved by using bismuth and non-bismuth-based quadruple therapies. In conclusion, the approach to the diagnostics and treatment of H. pylori infection did not generally differ between younger and older patients. Main differences were reported in the concurrent medications, allergy to penicillin and adverse events both in first- and second-line treatment. Optimal effectiveness rates were mostly achieved by using bismuth and non-bismuth-based quadruple therapies. No clinically relevant differences in the effectiveness between the age groups were observed.

The Prevalence of Gastroesophageal Reflux Disease in Azerbaijan: A Population-Based Cross-sectional Study.

BACKGROUND/AIMS: The prevalence of gastroesophageal reflux disease in Azerbaijan has not been evaluated before. The aim of our study was to determine the prevalence of gastroesophageal reflux disease based on the validated reflux questionnaire. MATERIALS AND METHODS: A total of 1026 individuals from 7 regions of Azerbaijan were included in the cross-sectional study conducted via face-to-face administration of the validated Mayo Clinic's gastroesophageal reflux disease questionnaire. Gastroesophageal reflux disease was diagnosed if an individual had heartburn and/or regurgitation occurring at least once a week. RESULTS: The prevalence of gastroesophageal reflux disease in Azerbaijan was 22.7% with significant female predominance (26.1% vs. 15.3%; P < .0001). Gastroesophageal reflux disease was prevalent in 17% of those aged below 35 years; 22.7% of those in the age range 36-55 years, and 38.5% of those who are above 56 years, which, accordingly, indicates that gastroesophageal reflux disease becomes significant as age increased (P < .0001). Male respondents younger than 35 years had much lower rates of gastroesophageal reflux disease than in older groups (5.7% vs. 22.7%, P < .0001), whereas in females older than 55 years, age was a significant factor for increasing gastroesophageal reflux disease symptoms (22.6% vs. 50%, P < .001). Reflux was observed in 18.1% of normal-weight respondents (body mass index 18.6-24.9), 25.6% of overweight (body mass index 25-29.9), and 30.4% of obese ( body mass index > 30) individuals (P = .001). Regarding marital status, the prevalence was the lowest in the single subjects' group (17%), close to average in the married group (23.8%), and the highest (41.7%) in divorced/widowed cases (P = .003). Stress significantly affected the gastroesophageal reflux disease distribution, affecting 59.4% of all respondents (P < .004). CONCLUSION: Gender, body mass index, increased age, marital status, and stress were precipitating factors of gastroesophageal reflux disease. Socioeconomic diversity, along with lifestyle/habits, did not play a crucial role in the gastroesophageal reflux disease prevalence distribution.

Helicobacter pylori Diagnostic Tests Used in Europe: Results of over 34,000 Patients from the European Registry on Helicobacter pylori Management.

BACKGROUND AND AIMS: Several methods are available to diagnose Helicobacter pylori infection. Our objective was to evaluate the tests used for both the initial diagnosis and the confirmation of eradication after treatment in Europe. METHODS: The European Registry on the management of Helicobacter pylori infection is an international, multicentre, prospective, non-interventional registry aiming to evaluate the management of Helicobacter pylori-infected patients in Europe. Countries with at least 100 cases registered from June 2013 to April 2021, and with a validated diagnostic method were analysed. Data were quality reviewed. RESULTS: A total of 34,920 adult patients from 20 countries were included (mean age 51 years; 61% women). To establish the initial diagnosis, invasive tests were performed in 19,801 (71%) patients, non-invasive in 11,369 (41%), and both in 3437 (12%). The most frequent were histology (n = 11,885; 43%), a rapid urease test (n = 10,636; 38%) and an urea breath test (n = 7577; 27%). According to the age, invasive tests were indicated in 11,179 (77%) ≥50 years, and in 8603 (65%) <50 years. Depending on the country, the use of invasive tests ranged from 29-99% in <50 years to 60-99% in ≥50. Most of the tests used to confirm eradication were non-invasive (n = 32,540; 93%), with the urea breath test being the most frequent (n = 32,540; 78%). In 2983 (9%) post-treatment tests, histology (n = 1887; 5%) or a rapid urease test (n = 1223; 4%) were performed. CONCLUSION: A great heterogeneity was observed for the initial diagnosis and confirmation of the eradication. The reasons for the apparent lack of adherence to the clinical guidelines should be further explored.

APPLICATION OF INTELLECTUAL MONITORING INFORMATION TECHNOLOGY IN DETERMINING THE SEVERITY OF THE CONDITION OF PATIENTS WITH INFLAMMATORY BOWEL DISEASES.

OBJECTIVE: The aim: Was to evaluate the effectiveness of the use of information technology of intelligent monitoring in solving the problems of assessing the morbidity of a patient with IBD during treatment. PATIENTS AND METHODS: Matherials and methods: 183 patients with IBD were observed. Among them 104(56.8%) patients suffered from Crohn's disease and 79(43.1%) patients had ulcerative colitis. For each patient and each disease, the formation of a list of signs, the extraction of information and knowledge will be carried out according to an individual method. At the lower level, tasks are performed: determination of the list of patient morbidity conditions, the formation of a list of indicators of the patient morbidity conditions, their identification as classes for machine learning models; formation of a list of signs, which identify the state of the patient's morbidity and whose characteristics obtained after results of medical tests. RESULTS: Results: The number of correctly classified points reached 92%. An analysis of the conditions of patients characterized by incorrectly classified points revealed the information content of this fact. In those cases when the classification results did not coincide with the expert assessment of the patient's condition, additional factors were found that influenced his condition and whose characteristics were not taken into account in the structure of classifier models. CONCLUSION: Conclusions: The results of the testing of classifier models indicate the effectiveness of the use of information technology of intelligent monitoring to assess the condition of patients with IBD.