Abstract：
BACKGROUND: Gastric cancer (GC) is one of the most lethal malignancies worldwide. Helicobacter pylori is the primary cause of GC; therefore, its eradication reduces the risk of developing this neoplasia. There is extensive evidence regarding quadruple therapy with relevance to the European population. However, in Latin America, data are scarce. Furthermore, there is limited information about the eradication rates achieved by antibiotic schemes in European and Latin American populations.
OBJECTIVE: To compare the effectiveness of standard triple therapy (STT), quadruple concomitant therapy (QCT), and bismuth quadruple therapy (QBT) in six centers in Europe and Latin America.
METHODS: A retrospective study was carried out based on the LEGACy registry from 2017 to 2022. Data from adult patients recruited in Portugal, Spain, Chile, Mexico, and Paraguay with confirmed H. pylori infection who received eradication therapy and confirmatory tests at least 1 month apart were included. Treatment success by each scheme was compared using a mixed multilevel Poisson regression, adjusting for patient sex and age, together with country-specific variables, including prevalence of H. pylori antibiotic resistance (clarithromycin, metronidazole, and amoxicillin), and CYP2C19 polymorphisms.
RESULTS: 772 patients were incorporated (64.64% females; mean age of 52.93 years). The total H. pylori eradication rates were 75.20% (255/339) with STT, 88.70% (159/178) with QCT, and 91.30% (191/209) with QBT. Both quadruple therapies (QCT-QBT) showed significantly higher eradication rates compared with STT, with an adjusted incidence risk ratio (IRR) of 1.25 (p: <0.05); and 1.24 (p: <0.05), respectively. The antibiotic-resistance prevalence by country, but not the prevalence of CYP2C19 polymorphism, showed a statistically significant impact on eradication success.
CONCLUSIONS: Both QCT and QBT are superior to STT for H. pylori eradication when adjusted for country-specific antibiotic resistance and CYP2C19 polymorphism in a sample of individuals residing in five countries within two continents.
OBJECTIVE: To compare the effectiveness of standard triple therapy (STT), quadruple concomitant therapy (QCT), and bismuth quadruple therapy (QBT) in six centers in Europe and Latin America.
METHODS: A retrospective study was carried out based on the LEGACy registry from 2017 to 2022. Data from adult patients recruited in Portugal, Spain, Chile, Mexico, and Paraguay with confirmed H. pylori infection who received eradication therapy and confirmatory tests at least 1 month apart were included. Treatment success by each scheme was compared using a mixed multilevel Poisson regression, adjusting for patient sex and age, together with country-specific variables, including prevalence of H. pylori antibiotic resistance (clarithromycin, metronidazole, and amoxicillin), and CYP2C19 polymorphisms.
RESULTS: 772 patients were incorporated (64.64% females; mean age of 52.93 years). The total H. pylori eradication rates were 75.20% (255/339) with STT, 88.70% (159/178) with QCT, and 91.30% (191/209) with QBT. Both quadruple therapies (QCT-QBT) showed significantly higher eradication rates compared with STT, with an adjusted incidence risk ratio (IRR) of 1.25 (p: <0.05); and 1.24 (p: <0.05), respectively. The antibiotic-resistance prevalence by country, but not the prevalence of CYP2C19 polymorphism, showed a statistically significant impact on eradication success.
CONCLUSIONS: Both QCT and QBT are superior to STT for H. pylori eradication when adjusted for country-specific antibiotic resistance and CYP2C19 polymorphism in a sample of individuals residing in five countries within two continents.
摘要：
背景：胃癌（GC）是世界范围内最致命的恶性肿瘤之一。幽门螺杆菌是GC的主要原因；因此，它的根除降低了发展这种肿瘤的风险。有大量证据表明四联疗法与欧洲人口有关。然而,在拉丁美洲，数据稀缺。此外，关于抗生素方案在欧洲和拉丁美洲人群中根除率的信息有限.
目的：比较标准三联疗法（STT）的有效性，四联伴随治疗（QCT），和铋四联疗法（QBT）在欧洲和拉丁美洲的六个中心。
方法：根据2017年至2022年的LEGACy注册中心进行了一项回顾性研究。来自葡萄牙招募的成年患者的数据，西班牙,智利,墨西哥,纳入了确诊幽门螺杆菌感染的巴拉圭,他们接受根除治疗和至少间隔1个月的确证试验.使用混合多水平泊松回归比较每种方案的治疗成功率，适应病人的性别和年龄，连同特定国家的变量，包括幽门螺杆菌抗生素耐药性的患病率(克拉霉素，甲硝唑,和阿莫西林)，和CYP2C19多态性。
结果：纳入772例患者（64.64％为女性；平均年龄52.93岁）。STT组幽门螺杆菌总根除率为75.20%(255/339),88.70%（159/178）与QCT，和91.30%（191/209）与QBT。与STT相比，两种四联疗法（QCT-QBT）均显示出明显更高的根除率，调整后的发病率风险比（IRR）为1.25（p：<0.05）；1.24（p：<0.05），分别。按国家分列的抗生素耐药性患病率，但不是CYP2C19多态性的患病率，对根除成功率有统计学意义的影响。
结论：在居住在两大洲五个国家的个体样本中，根据国家特异性抗生素耐药性和CYP2C19多态性调整后，QCT和QBT在根除幽门螺杆菌方面均优于STT。
目的：比较标准三联疗法（STT）的有效性，四联伴随治疗（QCT），和铋四联疗法（QBT）在欧洲和拉丁美洲的六个中心。
方法：根据2017年至2022年的LEGACy注册中心进行了一项回顾性研究。来自葡萄牙招募的成年患者的数据，西班牙,智利,墨西哥,纳入了确诊幽门螺杆菌感染的巴拉圭,他们接受根除治疗和至少间隔1个月的确证试验.使用混合多水平泊松回归比较每种方案的治疗成功率，适应病人的性别和年龄，连同特定国家的变量，包括幽门螺杆菌抗生素耐药性的患病率(克拉霉素，甲硝唑,和阿莫西林)，和CYP2C19多态性。
结果：纳入772例患者（64.64％为女性；平均年龄52.93岁）。STT组幽门螺杆菌总根除率为75.20%(255/339),88.70%（159/178）与QCT，和91.30%（191/209）与QBT。与STT相比，两种四联疗法（QCT-QBT）均显示出明显更高的根除率，调整后的发病率风险比（IRR）为1.25（p：<0.05）；1.24（p：<0.05），分别。按国家分列的抗生素耐药性患病率，但不是CYP2C19多态性的患病率，对根除成功率有统计学意义的影响。
结论：在居住在两大洲五个国家的个体样本中，根据国家特异性抗生素耐药性和CYP2C19多态性调整后，QCT和QBT在根除幽门螺杆菌方面均优于STT。
