Article Text

Download PDFPDF
European Registry on Helicobacter pylori management shows that gastroenterology has largely failed in its efforts to guide practitioners
  1. David Y Graham1,
  2. Hashem B El-Serag2
  1. 1Medicine (111D), Baylor College of Medicine, Houston, Texas, USA
  2. 2Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr David Y Graham, Medicine (111D), Baylor College of Medicine, Houston, TX 77030, USA; dgraham{at}

Statistics from


The authors report the results of a 5-year (2013–2018) audit of the effectiveness of Helicobacter pylori therapy in clinical practice in several regions of Europe.1 The study provides a contemporary prospective regarding empirical H. pylori treatment. Importantly, there was little centralised influence on choice of therapy apart from sending periodic updates, presenting updates at the meeting of the European H. pylori study group and including local feedback in the form of post-treatment testing for cure. The strengths of the report include the large sample size, representative population, and high level of complete data on treatment type, duration and follow-up. Overall, 30 394 patients from 27 European countries provided data on 21 533 first-line empirical H. pylori treatments using more than 100 different schemes. Antibiotic susceptibility data were obtained from 11% (2.7% to 16.7% in different regions). In that small sample, the prevalence of H. pylori resistance to clarithromycin and metronidazole was high (ie, 23% and 32%, respectively). Clarithromycin triple therapy was most commonly used but use declined over time from >50% in 2013–2015 to 32% in 2017–2018. The use of bismuth quadruple therapy was uncommon and varied markedly between regions but also tended to increase over time. They concluded that the management of H. pylori infection by European gastroenterologists was heterogeneous, suboptimal and discrepant with current recommendations.

There seems to be an ongoing slow paradigm shift from therapies identified by trial and …

View Full Text


  • Contributors All authors have read and approved the final manuscript and each meets the criteria for authorship established by the International Committee of Medical Journal Editors and verify the validity of the results reported. We confirm that our paper has not been published in its current form or a substantially similar form (in print or electronically, including on a website), that it has not been accepted for publication elsewhere and that it is not under consideration by another publication.

  • Funding DYG and HE-S are supported in part by the Office of Research and Development Medical Research Service Department of Veterans Affairs, Public Health Service grant DK56338 which funds the Texas Medical Center Digestive Diseases Center.

  • Competing interests DYG is a consultant for RedHill Biopharma and Phathom Pharmaceuticals regarding novel Helicobacter pylori therapies and has received research support for culture of H. pylori and is the PI of an international study of the use of antimycobacterial therapy for Crohn’s disease. HE-S is a consultant for Phathom Pharmaceuticals regarding novel H. pylori therapies.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.