RT Journal Article SR Electronic T1 European Registry on Helicobacter pylori management (Hp-EuReg): patterns and trends in first-line empirical eradication prescription and outcomes of 5 years and 21 533 patients JF Gut JO Gut FD BMJ Publishing Group Ltd and British Society of Gastroenterology SP 40 OP 54 DO 10.1136/gutjnl-2020-321372 VO 70 IS 1 A1 Olga P Nyssen A1 Dmitry Bordin A1 Bojan Tepes A1 Ángeles Pérez-Aisa A1 Dino Vaira A1 Maria Caldas A1 Luis Bujanda A1 Manuel Castro-Fernandez A1 Frode Lerang A1 Marcis Leja A1 Luís Rodrigo A1 Theodore Rokkas A1 Limas Kupcinskas A1 Jorge Pérez-Lasala A1 Laimas Jonaitis A1 Oleg Shvets A1 Antonio Gasbarrini A1 Halis Simsek A1 Anthony T R Axon A1 György Buzás A1 Jose Carlos Machado A1 Yaron Niv A1 Lyudmila Boyanova A1 Adrian Goldis A1 Vincent Lamy A1 Ante Tonkic A1 Krzysztof Przytulski A1 Christoph Beglinger A1 Marino Venerito A1 Peter Bytzer A1 Lisette Capelle A1 Tomica Milosavljević A1 Vladimir Milivojevic A1 Lea Veijola A1 Javier Molina-Infante A1 Liudmila Vologzhanina A1 Galina Fadeenko A1 Ines Ariño A1 Giulia Fiorini A1 Ana Garre A1 Jesús Garrido A1 Cristina F Pérez A1 Ignasi Puig A1 Frederic Heluwaert A1 Francis Megraud A1 Colm O'Morain A1 Javier P Gisbert A1 , YR 2021 UL http://gut.bmj.com/content/70/1/40.abstract AB Objective The best approach for Helicobacter pylori management remains unclear. An audit process is essential to ensure clinical practice is aligned with best standards of care.Design International multicentre prospective non-interventional registry starting in 2013 aimed to evaluate the decisions and outcomes in H. pylori management by European gastroenterologists. Patients were registered in an e-CRF by AEG-REDCap. Variables included demographics, previous eradication attempts, prescribed treatment, adverse events and outcomes. Data monitoring was performed to ensure data quality. Time-trend and geographical analyses were performed.Results 30 394 patients from 27 European countries were evaluated and 21 533 (78%) first-line empirical H. pylori treatments were included for analysis. Pretreatment resistance rates were 23% to clarithromycin, 32% to metronidazole and 13% to both. Triple therapy with amoxicillin and clarithromycin was most commonly prescribed (39%), achieving 81.5% modified intention-to-treat eradication rate. Over 90% eradication was obtained only with 10-day bismuth quadruple or 14-day concomitant treatments. Longer treatment duration, higher acid inhibition and compliance were associated with higher eradication rates. Time-trend analysis showed a region-dependent shift in prescriptions including abandoning triple therapies, using higher acid-inhibition and longer treatments, which was associated with an overall effectiveness increase (84%–90%).Conclusion Management of H. pylori infection by European gastroenterologists is heterogeneous, suboptimal and discrepant with current recommendations. Only quadruple therapies lasting at least 10 days are able to achieve over 90% eradication rates. European recommendations are being slowly and heterogeneously incorporated into routine clinical practice, which was associated with a corresponding increase in effectiveness.