Lack of follow-up in Helicobacter pylori eradication treatment: Results from the European registry on Helicobacter pylori management

Table 1 Baseline characteristics of the groups, n (%)

Baseline characteristics	Retreatment (n = 5954)	Non-retreatment
		Overall (n = 950)	Medical perspective (n = 393)	Patient perspective (n = 474)
Sex
Male	2100 (35.3)	386 (40.6)	147 (37.4)	206 (43.5)
Female	3850 (64.7)	564 (59.4)	246 (62.6)	268 (56.5)
Age (years)
18-70	5455 (91.6)	851 (89.5)	350 (89.1)	430 (90.7)
≥ 71	475 (7.9)	96 (10.1)	40 (10.9)	44 (9.3)
Ethnic background
Caucasian	5148 (86.6)	810 (85.3)	344 (87.6)	391 (82.5)
Afro-American	70 (1.2)	8 (0.8)	5 (1.3)	1 (0.2)
Asian	79 (1.3)	12 (1.3)	7 (1.8)	3 (0.6)
Others	405 (6.8)	63 (6.6)	34 (8.6)	25 (5.3)
Indication
Non-investigated dyspepsia	1649 (27.7)	166 (17.5)	67 (17)	93 (19.6)
Dyspepsia with a normal gastroscopy	2664 (44.7)	507 (53.5)	203 (51.7)	254 (53.6)
Duodenal ulcer	451 (7.6)	64 (6.7)	24 (6.1)	34 (7.2)
Gastric ulcer	325 (5.5)	74 (7.8)	34 (8.7)	34 (7.2)
Others	390 (6.6)	64 (6.7)	31 (7.9)	25 (5.3)
Preneoplastic lesions1	156 (2.6)	27 (2.8)	12 (3.1)	13 (2.7)
Chronic use of NSAIDs or ASA	13 (0.2)	5 (0.5)	1 (0.3)	3 (0.6)
Chronic use of PPIs	29 (0.5)	3 (0.3)	1 (0.3)	2 (0.4)
Antecedent of resected GC	8 (0.1)	2 (0.2)	2 (0.5)	0 (0)
MALT lymphoma	8 (0.1)	2 (0.2)	2 (0.5)	0 (0)
1st degree relative of a patient with GC	127 (2.1)	13 (1.4)	6 (1.5)	6 (1.3)
Unexplained iron deficiency anemia	103 (1.7)	18 (1.9)	8 (2)	7 (1.5)
Idiopathic thrombocytopenic purpura	4 (0.1)	0 (0)	0 (0)	0 (0)
Vitamin B12 deficiency	27 (0.5)	5 (0.5)	2 (0.5)	3 (0.6)
Indication2
Highly recommended	1075 (18.1)	182 (19.2)	80 (20.4)	87 (18.4)
Poorly recommended	4879 (81.9)	768 (80.8)	313 (79.6)	387 (81.6)

¹Preneoplastic lesions: Chronic atrophic gastritis and intestinal metaplasia.

²Highly recommended: Preneoplastic lesions, personal history of gastric cancer with surgical and/or endoscopic resection, 1^st degree relatives of patients with gastric cancer, mucosa-associated lymphoid tissue lymphoma, and gastric or duodenal ulcers. Poorly recommended: Functional and uninvestigated dyspepsia, vitamin B12 deficiency, treatment with nonsteroidal anti-inflammatory drugs or acetylsalicylic acid, prolonged treatment with proton pump inhibitors, iron deficiency anemia, idiopathic thrombocytopenic purpura.

NSAID: Nonsteroidal anti-inflammatory drug; ASA: Acetylsalicylic acid; PPI: Proton pump inhibitor; MALT: Mucosa-associated lymphoid tissue; GC: Gastric cancer.

Table 2 Reasons for non-retreatment, n (%)

	Overall (n = 950)	Medical perspective (n = 393)	Patient perspective (n = 474)
Patient decision	474 (49.9)		474 (100)
Medical decision	393 (41.3)
Low tolerance		70 (17.8)
Unclear indication		70 (17.8)
Asymptomatic		62 (15.8)
Others		55 (14)
Multiple previous attempts		41 (10.4)
No compliance		29 (7.4)
Age and/or comorbidities		26 (6.6)
Allergy		15 (3.8)
Treatment not available		11 (2.8)
Pregnancy		8 (2)
Antibiotic resistance		6 (1.5)
Others	83 (8.7)

Table 3 Factors associated with non-retreatment of Helicobacter pylori after a therapeutic failure-univariate analysis, n (%)

Variables	Retreatment (n = 5954)	Non-retreatment
		Overall (n = 950)		Medical perspective (n = 393)		Patient perspective (n = 474)
		n (%)	P value	n (%)	P value	n (%)	P value
Sex
Male	2100 (35.3)	386 (40.6)	0.002	147 (37.4)	0.397	206 (43.5)	0.000
Female	3850 (64.7)	564 (59.4)		246 (62.6)		268 (56.5)
Age, years
18-70	5455 (91.6)	851 (89.5)	0.018	350 (89.1)	0.116	430 (90.7)	0.329
≥ 71	475 (7.9)	96 (10.1)		40 (10.9)		44 (9.3)
Ethnicity
Caucasian	5148 (86.6)	810 (85.3)	0.084	344 (87.6)	0.012	391 (82.5)	0.000
Afro-American	70 (1.2)	8 (0.8)		5 (1.3)		1 (0.2)
Asian	79 (1.3)	12 (1.3)		7 (1.8)		3 (0.6)
Others	405 (6.8)	63 (6.6)		34 (8.6)		25 (5.3)
Reclassified indication1
Highly recommended	1075 (18.1)	182 (19.2)	0.413	80 (20.4)	0.252	87 (18.4)	0.871
Poorly recommended	4879 (81.9)	768 (80.8)		313 (79.6)		387 (81.6)
Number of previous eradication attempts			0.000		0.000		0.000
None	4381 (73.6)	561 (59.1)		194 (49.4)		320 (67.5)
One attempt	1054 (17.7)	181 (19.1)		82 (20.9)		82 (17.3)
Two attempts	334 (5.6)	105 (11.1)		61 (15.5)		26 (5.5)
Three attempts	115 (1.9)	63 (6.6)		39 (9.9)		21 (4.4)
Four attempts	42 (0.7)	27 (2.8)		12 (3.1)		10 (2.1)
Five attempts	28 (0.5)	13 (1.4)		5 (1.3)		5 (1.1)
Treatment compliance2	5647 (94.8)	739 (77.8)	0.000	303 (77.1)	0.000	358 (75.5)	0.000
At least one AE	1277 (21.4)	234 (24.6)	0.051	103 (26.2)	0.046	116 (24.5)	0.193
Severe AE3	137 (2.3)	44 (4.6)	0.000	24 (6.1)	0.000	18 (3.8)	0.041
Serious AE4	9 (0.2)	5 (0.5)	0.017	5 (1.3)	0.000	0	0.397
Interruption by AE	183 (3.1)	109 (11.5)	0.000	68 (17.3)	0.000	39 (8.2)	0.000

¹Highly recommended: Preneoplastic lesions, personal history of gastric cancer with surgical and/or endoscopic resection, 1^st degree relatives of patients with gastric cancer, mucosa-associated lymphoid tissue lymphoma, and gastric or duodenal ulcers. Poorly recommended: Functional and uninvestigated dyspepsia, vitamin B12 deficiency, treatment with nonsteroidal anti-inflammatory drugs or acetylsalicylic acid, prolonged treatment with proton pump inhibitors, iron deficiency anemia, idiopathic thrombocytopenic purpura.

²Compliance: > 90% drug intake.

³Severe adverse event: Refers to the intensity of the symptoms.

⁴Serious adverse event: Unexpected medical occurrence, such as life-threatening, risk of hospitalization, or malformations.

AE: Adverse event.

Table 4 Factors associated with non-retreatment of Helicobacter pylori after a therapeutic failure-multivariate analysis, n (%)

Variables	Retreatment (n = 5954)	Non-retreatment
		Overall (n = 950)			Medical perspective (n = 393)			Patient perspective (n = 474)
		n (%)	P value	OR (95%CI)	n (%)	P value	OR (95%CI)	n (%)	P value	OR (95%CI)
Sex
Male	2100 (35.3)	386 (40.6)	0.000	1.30 (1.12-1.50)	147 (37.4)	0.116		206 (43.5)	0.004	1.34 (1.10-1.63)
Female	3850 (64.7)	564 (59.4)			246 (62.6)			268 (56.5)
Age, years
18-70	5455 (91.6)	851 (89.5)	0.015	1.35 (1.06-1.72)	350 (89.1)	0.028	1.49 (1.04-2.13)	430 (90.7)	0.282
≥ 71	475 (7.9)	96 (10.1)			40 (10.2)			44 (9.3)
Reclassified indication1
Highly recommended	1075 (18.1)	182 (19.2)	0.989		80 (20.4)	0.536		87 (18.4)	0.765
Poorly recommended	4879 (81.9)	768 (80.8)			313 (79.6)			387 (81.6)
Number of previous eradication attempts
One attempt	1054 (17.7)	181 (19.1)	0.000	1.57 (1.30-1.89)	82 (20.9)	0.000	2.07 (1.57-2.73)	82 (17.3)	0.109
Two attempts	334 (5.6)	105 (11.1)	0.000	2.82 (2.21-3.61)	61 (15.5)	0.000	4.89 (3.54-6.74)	26 (5.5)	0.006	1.69 (1.16-2.44)
Three attempts	115 (1.9)	63 (6.6)	0.000	5.05 (3.63-7.03)	39 (9.9)	0.000	9.25 (6.15-13.93)	21 (4.4)	0.000	2.91 (1.78-4.76)
Four attempts	42 (0.7)	27 (2.8)	0.000	6.00 (3.61-9.96)	12 (3.1)	0.000	7.84 (3.96-15.53)	10 (2.1)	0.000	3.60 (1.75-7.41)
Five attempts	28 (0.5)	13 (1.4)	0.000	4.04 (2.04-8.02)	5 (1.3)	0.002	4.73 (1.75-12.77)	5 (1.1)	0.073
Treatment compliance2	5647 (94.8)	739 (77.8)	0.000	6.07 (4.97-7.41)	303 (77.1)	0.000	4.27 (2.64-2.93)	358 (75.5)	0.000	10.04 (7.37-13.68)
Severe AE3	137 (2.3)	44 (4.6)	0.665		24 (6.1)	0.621		18 (3.8)	0.535
Serious AE4	9 (0.2)	5 (0.5)	0.642		5 (1.3)	0.261		NA	NA
Interruption by AE	183 (3.1)	109 (11.5)	0.053		68 (17.3)	0.010	2.06 (1.19-3.56)	39 (8.2)	0.000	0.34 (0.22-0.55)

¹Highly recommended: Preneoplastic lesions, personal history of gastric cancer with surgical and/or endoscopic resection, 1^st degree relatives of patients with gastric cancer, mucosa-associated lymphoid tissue lymphoma, and gastric or duodenal ulcers. Poorly recommended: Functional and uninvestigated dyspepsia, vitamin B12 deficiency, treatment with nonsteroidal anti-inflammatory drugs or acetylsalicylic acid, prolonged treatment with proton pump inhibitors, iron deficiency anemia, idiopathic thrombocytopenic purpura.

²Compliance: > 90% drug intake.

³Severe adverse event: Refers to the intensity of the symptoms.

⁴Serious adverse event: Unexpected medical occurrence, such as life-threatening, risk of hospitalization, or malformations.

AE: Adverse event; NA: Not appliable; OR: Odds ratio; CI: Confidence interval.