PDF | https://doi.org/10.46613/congastro2023-82
This work is licensed under CC BY 4.0
Medel-Jara P1, Reyes D2, Fuentes-López E3, Anton R4, Jimenez E5, Caballero C6, Boggino H6, Cantero D7, Barros R8, Santos-Antunes J8, Diez M9, Quiñones L10, Riquelme E11, Rollán A12, Cerpa L10, Valdés I13, P Nyssen O14, Moreira L15, P Gisbert J14, Camargo C16, Fleitas T4, Riquelme A2
1Doctorado en Epidemiología UC, Santiago, Chile
2Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
3Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
4Hospital Clínico Universitario de Valencia, Valencia, España
5Universidad de Valencia, Valencia, España
69. GenPat Laboratory, Asunción, Paraguay
7Instituto de Previsión Social, Asunción, Paraguay
8University of Porto, Porto, Chile
915. Vall d´Hebron University, Barcelona, España
10Faculty of Medicine, University of Chile, Santiago, Chile
11Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Santiago, Chile
12Facultad de Medicina Clínica Alemana – Universidad del Desarrollo, Santiago, Chile
13Universidad Mayor, Santiago, Chile
14Universidad Autónoma de Madrid, Madrid, España
15University of Barcelona, Barcelona, España
16National Cancer Institute, Bethesda MAryland, Estados Unidos (EEUU)
Introduction: Gastric cancer is one of the most lethal malignancies worldwide. Eradication of Helicobacter pylori (H. pylori) infection, its primary cause reduces the risk of gastric cancer. There is limited information comparing eradication rates of antibiotic schemes that includes European and Latin American populations.
Objective: To compare the effectiveness of Standard Triple Therapy (STT), Quadruple non-bismuth Concomitant Therapy (QCT), and Quadruple Bismuth Therapy (QBT) in six centers in Europe and Latin America: Portugal, Spain, Chile, Mexico, and Paraguay.
Methods: This is a retrospective study based on the LEGACY registry from 2017 to 2022 in Portugal, Spain, Chile, Mexico, and Paraguay. The inclusion criteria were being diagnosed as H. pylori-positive individuals, receiving eradication treatment, and having undergone an eradication test at least one month after treatment. The outcome variable was the eradication rate, and the main independent variable was the scheme used. To compare the H. pylori treatment schemes, the statistical approach used was through Poisson multilevel multivariate regression, including sex, age, and ecological country-specific variables from available evidence, including H. pylori antibiotic resistance (clarithromycin, metronidazole, and amoxicillin), and the proportion of CYP2C19 polymorphism corresponding to extensive metabolizer for proton pump inhibitors (Table 1).
Results: The study included 873 patients, 64% females, with a mean age of 54 years (52.6-54.7). The H. pylori eradication rates were 75.2% for STT, 89.3% for QCT, and 91.3% for QBT. Both therapies (QCT-QBT) had statistically significant differences vs. STT, with an Incidence Risk Ratio (IRR) of 1.25 (p-value: <0.01) for QCT and an IRR of 1.24 (p-value: <0.01) for QBT.
Conclusions: Quadruple therapies (both with and without bismuth) are superior to STT for H. pylori eradication regardless of country-specific H. pylori antibiotic resistance and CYP2C19 polymorphism in a sample of individuals belonging to five different countries and two continents.
