Effectiveness and safety of first-line empirical Helicobacter pylori eradication regimens in Switzerland: an interim analysis from a prospective multicentre registry (Hp-EuReg).

Abstract

Background:  Helicobacter pylori infection remains prevalent globally. Despite the relatively low reported prevalence in Switzerland, the actual burden is thought to be higher, primarily due to migration. To date, limited evidence is available regarding the effectiveness of Helicobacter pylori eradication therapy in Switzerland.

Methods: This is a sub-study of the European Registry on Helicobacter pylori Management (Hp-EuReg), an international, multicentre, prospective, non-interventional registry of the routine clinical practice of gastroenterologists. All adult patients with Helicobacter pylori infections were systematically registered in the AEG-REDCap electronic case report form from 2013 to December 2023. Swiss data were analysed for effectiveness on a modified intention-to-treat (mITT) basis, assessing both the therapy duration and the acid inhibition administered with treatment.

Results: A total of 486 adult patients diagnosed with Helicobacter pylori infection were evaluated. Of these, 428 (88%) were treatment-naïve patients. A total of 283 patients with available follow-up were evaluated for effectiveness, adverse events, and compliance. Two first-line regimens accounted for over 90% of cases: amoxicillin-clarithromycin triple therapy in 49% and 10-day single-capsule bismuth quadruple therapy (containing metronidazole-tetracycline-bismuth) in 42%. The overall modified intention-to-treat effectiveness was 92%, achieving 91% in the low-dose proton pump inhibitor (PPI) group (20 mg omeprazole equivalent twice daily) and 96% in the group receiving high-dose (80 mg omeprazole equivalent twice daily) proton pump inhibitors. The lowest effectiveness (82%, 28/34 cases) was reported with 7-day amoxicillin-clarithromycin triple therapy, while the highest effectiveness (97%, 100/103 cases) was achieved with single-capsule bismuth quadruple therapy. Regarding safety, the overall incidence of at least one adverse event was 8.5%, and no serious adverse events were reported.

Conclusions: In Switzerland, 10-day single-capsule bismuth quadruple therapy with metronidazole, tetracycline, and bismuth demonstrated high eradication success (>90%) and represents a promising empirical first-line treatment option in routine clinical practice.