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©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2026; 32(7): 113541
Published online Feb 21, 2026. doi: 10.3748/wjg.v32.i7.113541
Published online Feb 21, 2026. doi: 10.3748/wjg.v32.i7.113541
Lack of follow-up in Helicobacter pylori eradication treatment: Results from the European registry on Helicobacter pylori management
Elisa Cantú-Germano, Leticia Moreira, Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona 08036, Catalonia, Spain
Elisa Cantú-Germano, Leticia Moreira, Fetge I Sistema Digestiu, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona 08036, Catalonia, Spain
Elisa Cantú-Germano, Leticia Moreira, Facultat de Medicina I Ciències de la Salut, Universitat de Barcelona (UB), Barcelona 08036, Catalonia, Spain
Leticia Moreira, Samuel J Martínez-Domínguez, Luis Bujanda, Ana Garre, Alfredo J Lucendo, Pablo Parra, Olga P Nyssen, Javier P Gisbert, Enfermedades Hepáticas y Digestivas, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid 28029, Spain
Ángeles Pérez-Aisa, Department of Gastroenterology, Hospital Universitario Costa del Sol, Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Marbella 29603, Andalusia, Spain
Samuel J Martínez-Domínguez, Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza 50009, Aragon, Spain
Irina Voynovan, A.S. Loginov Moscow Clinical Scientific Center, Moskva, 111123, Russia
Luis Bujanda, Department of Gastroenterology, Biodonostia Health Research Institute, Department of Medicine, Universidad del País Vasco (UPV/EHU), San Sebastian 20014, Gipuzkoa, Spain
Laimas Jonaitis, Juozas Kupcinskas, Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas 50161, Lithuania
Bojan Tepes, Department of Gastroenterology, Diagnostic Center Rogaska, Rogaska Slatina 3250, Slovenia
Ana Garre, Pablo Parra, Olga P Nyssen, Javier P Gisbert, Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid 28006, Spain
Alfredo J Lucendo, Department of Gastroenterology, Hospital General de Tomelloso, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Tomelloso 13700, Castille-La Mancha, Spain
Frode Lerang, Østfold Hospital Trust, Grålum 1714, Norway
Thomas Butler, Trinity Academic Gastroenterology Group, Clinical Medicine, Trinity College Dublin, Department of Gastroenterology, Tallaght University Hospital, Dublin D02 PN40, Ireland
Umud Mahmudov, Modern Hospital, Baku AZ1119, Azerbaijan
Jose M Huguet, Department of Gastroenterology, General University Hospital of Valencia, Valencia 46014, Spain
Javier Tejedor-Tejada, Department of Gastroenterology, Hospital Universitario de Cabueñes, Gijón 33394, Asturias, Spain
Pavel Bogomolov, Universal Clinic Private Medical Center, Moskva 109382, Russia
Ian LP Beales, Department of Gastroenterology, Norwich Medical School, University of East Anglia, Norwich NR4 7UY, Norfolk, United Kingdom
Perminder S Phull, Department of Digestive Disorders, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, United Kingdom
Manuel Pabon-Carrasco, Manuel Castro-Fernández, Alma Keco-Huerga, Department of Gastroen
Sergey Alekseenko, Department of Hospital Therapy, Far Eastern State Medical University, Khabarovsk 680000, Russia
Matteo Pavoni, Department of Medical and Surgical Sciences, Sant’Orsola-Malpighi University Hospital, Bologna 40138, Italy
Oleg Zaytsev, First Clinical Medical Centre, Kovrov 301910, Vladimirskaya Oblast, Russia
Renate Bumane, Marcis Leja, Department of Gastroenterology, Digestive Diseases Centre, Institute of Clinical and Preventive Medicine, University of Latvia, Riga LV1079, Latvia
Maja Denkovski, Interni Oddelek, Diagnostic Centre, Bled 4620, Slovenia
Manuel D Cajal, Department of Gastroenterology and Hepatology, Hospital Universitario San Jorge, Huesca 22004, Aragon, Spain
Ilchishina Tatiana, Department of Gastroenterology, SM-clinic, Saint-Petersburg, Saint Petersburg 194355, Russia
Miguel Areia, Department of Gastroenterology, Portuguese Oncology Institute of Coimbra (IPO Coimbra), RISE@CI-IPO (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Coimbra 3000-075, Portugal
Gülüstan Babayeva, Department of Therapy, Azerbaijan State Advanced Training Institute for Doctors named after A. Aliyev, Baku 1072, Azerbaijan
Gülüstan Babayeva, Department of Internal Medicine and Gastroenterology, Memorial Clinic, Baku 1096, Azerbaijan
Fernando Bermejo, Department of Gastroenterology, University Hospital of Fuenlabrada, Fuenlabrada 28942, Spain
Halis Simsek, Department of Gastroenterology, Hacettepe University, Ankara 06690, Türkiye
György M Buzás, Department of Gastroenterology, Ferencváros Health Center, Budapest 1095, Hungary
Giuseppe Losurdo, Department of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari 70121, Puglia, Italy
Dmitry S Bordin, Department of Pancreatic, Biliary and Upper Digestive Tract Disorders, A.S. Loginov Moscow Clinical Scientific Center, Department of Outpatient Therapy and Family Medicine, Tver State Medical University, Department of Propaedeutic of Internal Diseases and Gastroenterology, Russian University of Medicine, Moscow 111123, Russia
Sinead M Smith, Colm O’Morain, School of Medicine, Trinity College, Dublin D02 PN40, Ireland
Antonio Gasbarrini, Department of Internal Medicine and Gastroenterology, Fondazione Policlínico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
Ricardo Marcos-Pinto, Department of Gastroenterology, Centro Hospitalar do Porto, Universidade do Porto, Instituto De Ciências Biomédicas de Abel Salazar, Center for Research in Health Technologies and Information Systems (CINTESIS), Porto 4099-001, Portugal
Cem Simsek, Department of Gastroenterology, Hacettepe University, Mehmet Akif Inan, Health Sciences University, Medical Center, HC International Clinic, Ankara 06800, Türkiye
Veronika Papp, Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest 1085, Hungary
Blas JG Rodríguez, Department of Gastroenterology, Hospital Universitario Virgen Macarena, Sevilla 41013, Spain
Pilar P Mejide, Department of Gastroenterology, Hospital de Cruces, Barakaldo 48903, Spain
Ramón P Villarroya, Department of Gastroenterology, Hospital Universitario Infanta Sofía, Facultad de Medicina, Universidad Europea de Madrid, Madrid 28702, Spain
Mónica S Alonso, Department of Gastroenterology, Hospital Universitario Santa Bárbara, Puertollano 13500, Castille-La Mancha, Spain
Anna Cano-Català, Department of Medicine, Gastrointestinal Oncology, Endoscopy and Surgery (GOES) research group, Althaia Xarxa Assistencial Universitària de Manresa, Institut de Recerca i Innovació en Ciències de la Vida i de la Salut de la Catalunya Central (IRIS-CC), Manresa 08243, Catalonia, Spain
Francis Megraud, INSERM U1312 BRIC, Université de Bordeaux, Bordeaeux 33076, France
Author contributions: Nyssen OP, scientific director and member of the project scientific committee, planned and coordinated the study, designed and programmed the electronic case report form, extracted, analyzed, synthesized, and interpreted the data, acted as a critical reviewer of the manuscript drafts; and approved the final submitted manuscript; Cantú-Germano E planned and coordinated the study, extracted, analyzed, synthesized, and interpreted the data, wrote the first draft and approved the final submitted manuscript; Pérez-Aísa A, Martínez-Domínguez SJ, Voynovan I, Bujanda L, Jonaitis L, Tepes B, Garre A, Lucendo AJ, Lerang F, Butler T, Mahmudov U, Huguet JM, Tejedor-Tejada J, Bogomolov P, Beales ILP, Phull PS, Pabón-Carrasco M, Castro-Fernández M, Alekseenko S, Pavoni M, Zaytsev O, Bumane R, Denkovski M, Cajal MD, Tatiana I, Areia M, Keco-Huerga A, Babayeva G, Bermejo F, Simsek H, Buzás GM, Losurdo G, Bordin DS, Kupcinskas J, Smith SM, Gasbarrini A, Leja M, Marcos-Pinto R, Simsek C, Papp V, Rodríguez BJG, Mejide PP, Villarroya RP, Alonso MS, Moreira L, and Gisbert JP acted as patient recruiters, critically reviewed the manuscript drafts, and approved the submitted manuscript; Moreira L, scientific director and member of the project scientific committee, analyzed, synthesized, and interpreted the data, contributed to the writing of the first draft, critically reviewed the manuscript drafts and approved the final submitted manuscript; Cano-Català A, Parra P, Megraud F, O’Morain C, Moreira L, Nyssen OP and Gisbert JP are members of the project scientific committee, critically reviewed the manuscript drafts, and approved the submitted manuscript; Gisbert JP, principal investigator of the project, who is a member of the scientific committee, obtained funding, designed the protocol and planned the study, analyzed and interpreted the data, recruited patients, critically reviewed the manuscript drafts, and approved the final submitted manuscript; On behalf of the European registry on Helicobacter pylori management investigators (the remaining list of authors, their affiliations, and contributions are listed in Supplementary material); Nyssen OP and Gisbert JP are both senior authors and contributed equally to the study.
Supported by the European Union program HORIZON, No. 101095359; and the European Union program EU4Health, No. 101101252.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of La Princesa University Hospital (Madrid, Spain), which acted as a reference Institutional Review Board (Ethics approval code: European registry on Helicobacter pylori management, 20/12/2012).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: Nyssen OP has served as a speaker or has received research funding from Allergan, Mayoly Spindler, Richen, Biocodex and Juvisé; Gisbert JP has served as speaker, consultant, and advisory member for or has received research funding from Mayoly, Allergan/Abbvie, Diasorin, Richen, Juvisé, and Biocodex; The remaining authors declare that they have no conflicts of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: All data relevant to the study are included in the article or uploaded as supplementary information. However, previously published data from the European registry on Helicobacter pylori management study or deidentified raw data from the current study, as well as further information on the methods used to explore the data, may be shared, with no particular time constraints. Individual participant data will not be shared.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Leticia Moreira, MD, Doctor, Department of Gastroenterology, Hospital Clínic de Barcelona, Carrer de Villarroel, 170, L’Eixample, Barcelona 08036, Catalonia, Spain. lmoreira@clinic.cat
Received: August 29, 2025
Revised: September 30, 2025
Accepted: December 30, 2025
Published online: February 21, 2026
Processing time: 161 Days and 17.7 Hours
Revised: September 30, 2025
Accepted: December 30, 2025
Published online: February 21, 2026
Processing time: 161 Days and 17.7 Hours
Abstract
BACKGROUND
The Maastricht VI/Florence consensus recommends the eradication of all Helicobacter pylori (H. pylori) infections. However, retreatment strategies remain inconsistent.
AIM
To evaluate the reasons for and factors associated with non-retreatment after H. pylori eradication treatment failure.
METHODS
A multicenter, prospective registry (European registry on H. pylori management) was used to evaluate the deci
RESULTS
Of the 6904 patients with eradication failure, 950 (14%) were not retreated: 41% due to medical decisions, 50% due to patient decisions, and 9% due to other reasons. Frequent reasons for non-retreatment included previous poor tolerance, noncompliance, unclear indications, and multiple eradication attempts. From a medical perspective, non-retreatment was associated with age ≥ 71 years [odds ratio (OR) = 1.49; 95% confidence interval (CI): 1.04-2.13], previous noncompliance (OR = 4.27; 95%CI: 2.64-6.93), treatment discontinuation due to adverse events (OR = 2.06; 95%CI: 1.19-3.56), and number of previous attempts (OR range: 2.07-9.25). From the patient perspective, the associated factors included male sex (OR = 1.34; 95%CI: 1.10-1.63), two to four previous eradication attempts (OR range: 1.69-3.60) and previous noncompliance (OR = 10.04; 95%CI: 7.37-13.68).
CONCLUSION
Up to 14% of European patients are not retreated after H. pylori eradication failure. Key barriers include advanced age, previous noncompliance and prior eradication failures. The decision to avoid retreatment was often patient-driven, although medical reasons were also relevant, highlighting the importance of shared decision-making and improved patient education.
Keywords: Helicobacter pylori; Eradication treatment; Eradication failure; Retreatment; European registry on Helicobacter pylori management
Core Tip: This multicenter European study found that 14% of patients in whom Helicobacter pylori (H. pylori) eradication treatment failed did not receive retreatment, often due to patient-driven decisions and medical considerations such as advanced age, previous noncompliance, and treatment intolerance. Identifying these barriers emphasizes the need for shared decision-making and enhanced patient education to improve management outcomes. These findings provide crucial insights into real-world challenges in H. pylori infection management and offer guidance for optimizing treatment strategies in line with the recommendations of Maastricht VI/Florence.