Lack of Usefulness of Literature‐Based Helicobacter pylori Resistance Data for Predicting First‐Line Empirical Treatment Effectiveness in the European Registry on H. pylori Management (Hp‐ EuReg )
Year: 2026
Type: article
Abstract: BACKGROUND: Helicobacter pylori (H. pylori) infection causes gastritis, peptic ulcer disease, and gastric cancer. Without an effective vaccine, eradication therapy remains crucial. However, increasing antibiotic resistance compromises treatment effectiveness. OBJECTIVE: To evaluate whether literature-based resistance data could predict first-line empirical treatment effectiveness. METHODS: Resistance rates for clarithromycin, metronidazole, and levofloxacin were extracted from bibliographic reviews and estimated for three timeframes: the treatment year, the preceding year, and the last five years average. These rates (2008-2024) were matched with outcomes from the European Registry on H. pylori Management (Hp-EuReg, WorldHpReg partner), a prospective real-world study involving 40 countries. Analyses included Spearman's correlations, multivariate logistic regressions adjusted for demographic, clinical, and therapeutic-related variables, bootstrap resampling stratified by eradication success, and Random Forest models. RESULTS: Analysis included 37,659 patients receiving first-line empirical treatment from 13 countries. Moderate negative correlations were observed between metronidazole and clarithromycin resistances for some regimens. In the regression model, including either contemporaneous or previous-year resistance rates, clarithromycin resistance showed a negligible positive association, while metronidazole resistance was negatively associated. In regimen-specific models, previous-year clarithromycin resistance was positively associated with success in concomitant therapy, whereas higher five-year mean clarithromycin resistance reduced eradication odds in quadruple clarithromycin-amoxicillin-bismuth therapy. Random Forest models identified compliance, proton-pump inhibitor dose, regimen duration, and treatment as the strongest predictors of eradication, while resistance variables contributed minimally. CONCLUSION: Literature-based resistance data are not useful for guiding real-world first-line H. pylori therapy, highlighting the need for individualized antibiotic susceptibility testing to obtain reliable resistance information. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02328131.
Source: Helicobacter
DOI: 10.1111/hel.70169
Authors: Ismail Kirrout, Olga P. Nyssen, Ángeles Pérez‐Aísa, Bojan Tepes, Irina N. Voynovan, Samuel J. Martínez‐Domínguez, Alfredo J. Lucendo, Ludmila G. Vologzanina, Matteo Pavoni, Sayar R. Abdulkhakov, Maja Denkovski, Javier Tejedor‐Tejada, Tatiana Ilchishina, Luis Bujanda, Aiman S. Sarsenbaeva, Jose M. Huguet, Oleg Zaytsev, Boris D. Starostin, Monica Perona, Antonietta G. Gravina, Manuel Pabón‐Carrasco, Sergey A. Alekseenko, Óscar Núñez, Miguel Areia, Jesús Barrio, Antonio Moreno Loro, Dmitry N. Andreev, Blas José Gómez Rodríguez, María Soledad Marcos, Inmaculada Ortiz‐Polo, Galina N. Tarasova, Igor Bakulin, Mónica Sánchez Alonso, Irene Arteagoitia, Virginia Flores, Manuel Jiménez‐Moreno, Dmitry S. Bordin, Antonio Gasbarrini, Ricardo Marcos‐Pinto, Wojciech Marlicz, Perminder S. Phull, Marino Venerito, Doron Boltin, Lyudmila Boyanova, Pablo Parra, Leticia Moreira, Francis Mégraud, Colm O'Morain, Nuria Montes, Javier P. Gisbert, the Hp‐EuReg investigators
Institutions: Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria, Hospital Universitario de La Princesa, Centre for Plant Biotechnology and Genomics, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa, Universidad Politécnica de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Universidad Autónoma de Madrid, Hospital Costa del Sol, Agencia Sanitaria Costa del Sol, Rogaška Medical Centre, Moscow Clinical Scientific Center, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria Aragón, Hospital General de Tomelloso, IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, University of Bologna, Kazan State Medical University, Kazan Federal University, Diagnostični center Bled, Hospital Universitario De Cabueñes, University of the Basque Country, Biogipuzkoa Health Research Institute, Hospital General Universitario De Valencia, Voronezh Regional Clinical Oncology Center, University of Campania "Luigi Vanvitelli", Hospital Universitario de Valme, Far Eastern State Medical University, Universidad San Pablo CEU, Hospital Universitario Sanitas La Moraleja, IPO Porto, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (Sacyl), Hospital Universitario Virgen del Rocío, Hospital Universitario Virgen Macarena, Hospital Universitario 12 De Octubre, Hospital Universitari i Politècnic La Fe, Rostov State Medical University, North-Western State Medical University named after I.I. Mechnikov, Hospital de Cruces, Hospital General Universitario Gregorio Marañón, Hospital Universitario de Burgos, Tver State Medical University, Università Cattolica del Sacro Cuore, Agostino Gemelli University Polyclinic, Universidade do Porto, Centre for Health Technology and Services Research, Centro Hospitalar do Porto, Instituto de Ciências Biomédicas Albel Salazar, Pomeranian Medical University, Aberdeen Royal Infirmary, University Hospital Magdeburg, Otto-von-Guericke-Universität Magdeburg, Tel Aviv University, Rabin Medical Center, Medical University of Sofia, Hospital Clínic de Barcelona, Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, Fundació de Recerca Clínic Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Université de Bordeaux, BoRdeaux Institute of onCology, Trinity College Dublin
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,150
Funders: Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria, UK Research and Innovation, European Commission, Universidad Politécnica de Madrid, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Asociación Española de Gastroenterología, European Health and Digital Executive Agency
OpenAlex ID: W7225315785