Role of compliance in Helicobacter pylori eradication treatment: Results of the European Registry on H. pylori management
Authors: Huguet Jose M. , Ferrer‐Barceló Luis , Suárez Patrícia , Barcelo‐Cerda Susana , Sempere Javier , Saracino Ilaria Maria , Fiorini Giulia , Vaira Dino , Pérez‐Aísa Ángeles , Jonaitis Laimas , Tepes Bojan , Castro‐Fernandez M. , Pabón‐Carrasco Manuel , Keco‐Huerga Alma , Voynovan Irina , Lucendo Alfredo J. , Lanas Ángel , Martínez‐Domínguez Samuel J. , Alfaro Almajano Enrique , Rodrigo Luis , Vologzanina Ludmila , Bordin Dmitry S. , Gasbarrini Antonio , Babayeva Gülüstan , Lerang Frode , Leja Mārcis , Kupčinskas Juozas , Rokkas Theodore , Marcos‐Pinto Ricardo , Meštrović Antonio , Gridnyev Oleksiy , Phull Perminder S. , Smith Sinead M. , Boltin Doron , Buzás György Miklós , Kral Jan , Şimşek Halis , Matysiak‐Budnik Tamara , Milivojevic Vladimir , Marlicz Wojciech , Venerito Marino , Boyanova Lyudmila , Doulberis Michael , Capelle Lisette G. , Cano‐Català Anna , Moreira Leticia , Nyssen Olga P. , Mégraud Francis , O’Morain Colm , Gisbert Javier P. ,   the Hp‐EuReg Investigators
Published: April 2024

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.