Commentary

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 …