PDF | https://doi.org/10.46613/congastro2023-144
This work is licensed under CC BY 4.0
Reyes Placencia D1, Remes-Troche J2, Laudanno O3, Otero W4, Piscoya A5, Ramírez J6, Otoya G7, Campos C8, Medel-Jara P1, Latorre G1, Chahuan J1, Arenas A9, Candia R1, Mansilla R10, Vargas J1, Hanna I11, Cano A2, Bosques F12, Coss E13, Velarde J14, Pérez A14, Félix F14, Morel E14, Higuera F15, Velasco Y15, Motola M15, González M16, Olalde Á16, Raña R17, Flores Á18, Ochoa L18, Gómez O19, Yamamoto J20, Valdovinos L20, Juárez E21, Guirao R21, Bretón G21, Ortiz N22, Ruiz E23, Icaza M24, Pizarro M1, Binder M1, Bustamante M1, Dukes E1, Martinez F1, Silva F1, Marulanda H4, Otero L25, Otero E25, Trespalacios A26, Ahumarán G27, Bedini O28, Rodriguez P29, Ustares F30, Moreno J8, Fuentes-López E1, Cano-Català A31, Moreira L32, P. Nyssen O33, P. Gisbert J33, Riquelme A1
1Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
2Institute of Medical-Biological Research, Universidad Veracruzana, Veracruz, México
3Medical Research Institute Doctor Alfredo Lanari, Buenos Aires, Argentina
4Universidad Nacional de Colombia, Bogotá, Colombia
5Guillermo Kaelin de la Fuente Hospital, EsSalud, Lima, Perú
6Clínica Liga Contra el Cáncer, Lima, Perú
7Guillermo Almenara Irigoyen Hospital, Lima, Perú
8Hospital Clínica Bíblica, San José, Costa Rica
9Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
10Facultad de Medicina y Ciencia, Universidad San Sebastián, sede Patagonia, Puerto Montt, Chile
11Hospital Alcívar, Guayaquil, Ecuador
12Tecnológico de Monterrey, Monterrey, Nuevo León, México
13Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX, México
14Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Guadalajara, Jalisco, México
15Hospital General de México, CDMX, México
16Instituto de Seguridad Social del Estado de México y Municipios (ISSEMyM), Toluca, Estado de México, México
17Hospital Español de México, CDMX, México
18ISSTECALI, Mexicali, Baja California, México
19Hospital Ángeles Puebla, Puebla, México
20Hospital Medica Sur, CDMX, México
21Hospital Juárez de México, CDMX, México
22UMAE, CMN Siglo XXI, IMSS, CDMX, México
23Instituto Nacional de Cancerología, CDMX, México
24Hospital Faro del Mayab, Mérida, Yucatán, México
25Centro de Gastroenterología y Endoscopía, Bogotá, Colombia
26Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia
27Clínica Monte Grande, Buenos Aires, Argentina
28Centro de Endoscopía Digestiva, Rosario, Argentina
29Instituto Modelo Córdoba, Córdoba, Argentina
30Sanatorio Lavalle, Jujuy, Argentina
31Endoscopy and Surgery (GOES) research group, Althaia Xarxa Assistencial Universitària de Manresa, 08243, Manresa, España
32Hospital Clínic de Barcelona, University of Barcelona, Barcelona, España
33Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), UAM and CIBERehd, Madrid, España
Background:
Helicobacter pylori infection is a public health problem in Latin America.
Objectives: Describe and evaluate the main Helicobacter pylori eradication therapies, their eradication rates, adherence, and side effects.
Methods: A multicenter, retrospective, international registry (Hp-LATAMReg) was conducted. Information about therapies used by gastroenterologists in six countries (Argentina, Chile, Colombia, Costa Rica, Mexico, and Peru) from 2015 to 2023 was registered in an e-CRF AEG-REDCap database. The modified intention-to-treat (mITT) effectiveness, safety, and adherence was analyzed for the first-line regimens. The mITT and the side effects rate of the schemes were compared by a Poisson multivariate regression, adjusted by sex, age, proton pump inhibitor (PPI) dose used in the schemes and the length of the treatment.
Results: 1,378 patients were registered, of which 1,218 (88%) were treatment-naïve. The most commonly prescribed first-line therapies (n=1,117, 81%) were analyzed: standard clarithromycin-based triple therapy (SCTT) (PPI-amoxicillin (A)-clarithromycin (C); n=405, 29%), PPI-C-A-Metronidazole (M) (n=219, 16%), dual therapy (DT) (PPI-A; n=139, 10%), PPI-M-Tetracycline (Tc)-Bismuth (B) (n=133, 9.7%), PPI-C-A-B (n=70, 5.1%), PPI-A-M-B (n=41, 3%), PPI-A-Levofloxacin (L) (n=39, 2.8%), PPI-M-Doxycycline (D)-B (n=37, 2.7%) and PPI-A-D-B (n=34, 2.5%). Most of the regimes were 14-day long (n=1,051, 96%), and administered high-dose PPIs (54 to 128 mg omeprazole equivalents b.i.d.) (n=548, 50%). The first-line mITT overall effectiveness ranged from 72% to 100%, being the DT, PPI-A-M-B, PPI-M-Tc-B, PPI-C-A-M and PPI-A-D-B significantly more effective than SCTT. Moreover, the DT, PPI-M-Tc-B, PPI-C-A-B and PPI-A-D-B schemes had significantly fewer side effects compared with SCTT. Good adherence, defined as 90% of drug intake, was observed in 98% (n=1,090), without differences between the schemes (p=0.16) (Table 1).
Conclusions: In Latin America, quadruple and dual therapies were superior to SCTT and were safer than standard triple therapy. SCTT should not be considered as a first-line eradication treatment in Latin America.
