Helicobacter pylori Eradication Primary Care First-Line Prescriptions: Data From 200,000 Patients in a Real-World Cohort

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter Pub Date : 2026-04-01 DOI:10.1111/hel.70122

Encarnación Fernández-Antón, Olga P. Nyssen, Gabriela Alonso-Martínez, Pablo Parra, Miguel Gil, Javier P. Gisbert, Francisco J. de Abajo

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Abstract

Background

Helicobacter pylori is a common infection primarily managed in primary care. Assessing real-world practices and guideline adherence is crucial for treatment optimisation. The study aims to assess current H. pylori management strategies using data from BIFAP, a Spanish primary care database.

Materials and Methods

Cohort study including patients aged ≥ 18 with recorded H. pylori infection (2003–2023) and corresponding treatment prescriptions. Infection cases were identified using ICD-9/10 and SNOMED-CT codes. Treatment patterns were based on Spanish and European guidelines. First-line treatment prescriptions were compared between primary (BIFAP) and specialized (European Registry, Hp-EuReg) care.

Results

A total of 211,972 H. pylori-infected subjects were identified. Over the study period (20 years), the predominant first-line treatments were: bismuth quadruple therapy including a proton-pump inhibitor (PPI) plus a single capsule containing bismuth-tetracycline-metronidazole (36%); PPI + clarithromycin-amoxicillin (30%); and PPI + clarithromycin-amoxicillin-metronidazole (26%). Single-capsule bismuth quadruple therapy was the most common in patients aged 18–64 and those with obesity, chronic kidney disease, or smokers, while PPI + clarithromycin-amoxicillin was more common in those aged ≥ 65 or with peptic ulcers. Since 2013, PPI + clarithromycin-amoxicillin use by general practitioners and gastroenterologists decreased, though it remained above 10% in primary care at study end. PPI + clarithromycin-amoxicillin-metronidazole increased since 2015, with higher use in specialized care (40%) vs. primary care (30%). In 2023, single-capsule bismuth quadruple therapy was the most prescribed regimen in both settings, accounting for ~60% of prescriptions.

Conclusions

Primary care H. pylori treatments are varied, with single-capsule bismuth quadruple therapy most prescribed. Guidelines are followed, but adoption is slower in primary than in specialized care.

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根除幽门螺杆菌初级保健一线处方：来自真实世界队列中200,000名患者的数据。

背景：幽门螺杆菌是一种常见的感染，主要在初级保健中处理。评估现实世界的实践和指南依从性对治疗优化至关重要。该研究旨在利用西班牙初级保健数据库BIFAP的数据评估当前的幽门螺杆菌管理策略。材料与方法：队列研究，纳入2003-2023年年龄≥18岁有幽门螺杆菌感染记录的患者及相应的治疗处方。采用ICD-9/10和SNOMED-CT编码对感染病例进行鉴定。治疗模式以西班牙和欧洲的指导方针为基础。比较了初级（BIFAP）和专科（Hp-EuReg）护理的一线治疗处方。结果：共鉴定出211,972名幽门螺旋杆菌感染者。在研究期间（20年），主要的一线治疗方法是：铋四联疗法，包括质子泵抑制剂（PPI）加含铋-四环素-甲硝唑的单胶囊（36%）；PPI +克拉霉素-阿莫西林（30%）；PPI +克拉霉素-阿莫西林-甲硝唑（26%）。单胶囊铋四联治疗在18-64岁、肥胖、慢性肾病或吸烟者中最常见，而PPI +克拉霉素-阿莫西林在≥65岁或消化性溃疡患者中更常见。自2013年以来，全科医生和胃肠科医生使用PPI +克拉霉素-阿莫西林的人数有所下降，但在研究结束时，这一比例在初级保健中仍高于10%。自2015年以来，PPI +克拉霉素-阿莫西林-甲硝唑的使用增加，在专科护理中的使用率（40%）高于初级保健（30%）。2023年，单胶囊铋四联疗法是两种情况下处方最多的方案，约占处方的60%。结论：初级保健治疗幽门螺杆菌的方法多种多样，以单粒铋四联疗法为主。指南是遵循的，但在初级保健中采用的速度比在专门保健中慢。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Helicobacter 医学-微生物学

CiteScore

8.40

自引率

9.10%

发文量

审稿时长

2 months

期刊介绍： Helicobacter is edited by Professor David Y Graham. The editorial and peer review process is an independent process. Whenever there is a conflict of interest, the editor and editorial board will declare their interests and affiliations. Helicobacter recognises the critical role that has been established for Helicobacter pylori in peptic ulcer, gastric adenocarcinoma, and primary gastric lymphoma. As new helicobacter species are now regularly being discovered, Helicobacter covers the entire range of helicobacter research, increasing communication among the fields of gastroenterology; microbiology; vaccine development; laboratory animal science.