Registry of Helicobacter pylori: Now it is the turn of Latin America

The Latin American Registry of Helicobacter pylori (H. pylori) seeks to eradicate the bacterium in the regional population and control its impact on patients with chronic gastritis and the potential development of gastric cancer. H. pylori eradication therapy has been shown to reduce the risk of gastric cancer in people with or without preneoplastic lesions such as gastric intestinal metaplasia.

After the success evidenced by the European Report on H. pylori, a joint effort seeks to replicate the study, this time with a focus on Latin America. The objective is to improve the health of patients by eradicating the H. pylori bacteria, in order to avoid undesirable health consequences, but directly related to chronic gastritis and potentially gastric cancer, thus reducing the costs derived from care in health and effectively implementing the consensus guidelines on clinical practice in the management of this infection.

For the global researcher of the project at an international level, Dr. Javier Gisbert (Spain), the European Registry “has not only been widely disseminated by specialized medical publications, but also has the support of a very important network at European and global level of gastroenterologists, who work on the management of this infection and which has also allowed, based on clinical experience, to identify the most common errors in clinical practice, common among European gastroenterologists, which allows identifying the margin for improvement in management of H. pylori to optimize adherence to current clinical guidelines.

For the specialist, the advantage of the European experience is that it transmits the know-how of the project at all levels, which allows a simple, direct replication and quick start-up in all the countries of the world.

It is estimated that about half of the world’s population is chronically infected with H. pylori and presents chronic non-atrophic gastritis in most cases. In some people, chronic gastritis can lead to the loss of the mucous glands (atrophy), to the replacement of the gastric epithelium by the intestinal one (gastric intestinal metaplasia and dysplasia). Additionally, Dr. Gisbert states that: “H. pylori eradication therapy has been shown to reduce the risk of gastric cancer in people with or without gastric intestinal metaplasia, in the absence of gastric neoplasia. Follow-up of patients with MIG It is a strategy that has proven to be profitable in different health models”.

In this sense, in June 2022 the European Registry on the management of H. pylori infection (Hp-EuReg) was published – available at http://hpeureg.com/ and promoted by the European Helicobacter and Microbiota Study Group ( EHMSG)-, whose purpose was to systematically evaluate the epidemiology, efficacy and safety of the great diversity of treatments to eradicate H. pylori, as well as obtain a more global vision on the management of infection by this bacterium, and thus implement the relevant consensus documents and clinical practice guidelines in the different countries; and to assess accessibility to health technologies and medications used in the management of this infection.

The registry currently includes more than 53,000 patients from 300 centers in 29 countries across Europe. The registry allows the direct analysis of the eradication trends of the different treatments, the adaptation of treatment protocols according to local resistance data, as well as the indirect calculation of the profitability of therapeutic schemes.

As a balance, Dr. Javier Gisbert points out that “despite the efforts made, in Europe there has been a 10% increase in the global eradication rate of first-line treatments since the start of the study in 2013. This type of pathological records constitute a very powerful tool used to audit H. pylori eradication treatments, resulting in improved clinical management of the infection and, subsequently, helping to reduce other undesirable consequences for health, such as the development of gastric cancer.

THE TURN OF OUR REGION

Latin America is already working on its version of the registry and in this sense, under the leadership of Dr. Arnoldo Riquelme himself (Researcher responsible for the development of the Latin American Registry for the management of H. pylori infection (Hp LATAM Reg) together with the project coordinator ( Dr. Diego Reyes), with the support of Dr. Javier Gisbert and Dr. Leticia Moreira, representatives of several gastroenterology scientific societies, already share their first impressions:

Argentina
“For almost a year now, Argentina has been developing an Argentine Registry of H. pylori. For us, the Registry project (Hp LATAM Reg) led by Dr. Arnoldo Riquelme (Chile) is key. On the one hand, the support and ideas of He has been very valuable to start our Registry and also the possibility of entering the registry, with the particularity that the data will have according to the regions and countries.Likewise, in Argentina it is the possibility of starting to think about collaborative multicenter projects and integrating ourselves in the different Centers and Hospitals and I understand that Hp LATAM Reg is oriented towards this objective.

I do not want to fail to mention the European registry, which has been our model to follow. The possibility of having our own data to add to the LATAM Registry is invaluable, giving relevance to “Real World Evidence” and our expectation of incorporation opens up significant opportunities for us to start collaborative projects.

Currently 240 patients with complete eradication data are included. Centers from Buenos Aires and from different provinces such as Santa Fe, Córdoba, Jujuy and Mendoza participate. To date, several Centers are finishing their Regulatory stage in the Ethics Committee to enter.

Mexico
“Currently, Mexico has a population of 128 million inhabitants and it is estimated that after the age of 18, between 60 and 70% of this population are carriers of H. pylori. Thus, we are a population with a high prevalence of the infection and although it has been reduced (in the 1990s it was close to 80%), it is still considered a relevant health problem.In recent years, resistance to the triple eradication scheme (amoxicillin-clarithromycin- proton pump inhibitor) has become relevant, since its effectiveness is less than 70%, which together with the high prevalence form an adverse combination that affects the health of our population.

The fact that Mexico is integrated into the Hp LATAM Reg registry will allow a better understanding of how H. pylori infection behaves (from the clinical, biological and antimicrobial susceptibility point of view) in the different regions of our country and be able to compare it with the rest of Latin America. We firmly believe that this initiative will help define health policies and strategies that have served in other countries and adapt it to our reality. It will also allow the establishment of scientific and technological ties between the region, which is why we are undoubtedly convinced of the importance of projects such as the Hp LATAM Reg Registry. At the moment we are in the committee approval phase, but we hope to be able to start in the following months. actively”.

Colombia

“Colombia has a population of approximately 51 million inhabitants. The prevalence of H. pylori infection is estimated to be 60% in the adult population. The resistance found in H. pylori to different antibiotics is as follows: amoxicillin < 2%, tetracycline 2%, clarithromycin 25%, levofloxacin 27%, metronidazole >80%.Cure rates of infection with triple for 10 days, with clarithromycin (Amoxicillin 1 g twice daily, clarithromycin 500 mg twice daily day + proton pump inhibitor) is 71%, with levofloxacin 75%, with levofloxacin + clarithromycin 79%, overall 76%. All these cure rates are below 80%, being unacceptable. In the 90s the success of triple therapies was ≥90%.

The prevalence of rapid or ultra-rapid metabolizers of PPIs is 80%. Therefore, at our National University, we only use esomeprazole because it is minimally influenced by the type of metabolizer.

For us it is very important to be part of the Hp LATAM Hp registry for all that this implies for our continent and for the future to be able to carry out studies of the “real world” and as a continent; progressively identify the most effective therapies for each country or region. We agree with Professor Remes-Troche, that it will be a magnificent opportunity to unite scientifically and technologically. Also at the moment we are in the process of approval of the protocol by the ethics committees.”

Peru

“We have recently started the call and we hope to start collecting data shortly. This registry is extremely important in Peru because we have a high prevalence of H. pylori, close to 80% of the general population, and additionally, a high incidence of stomach cancer, which is the cancer with the highest lethality in our country.The relationship between H. pylori and stomach cancer has been recognized for several years and one of the strategies that needs to be implemented is the eradication of H. pylori, to This, the registry and its subsequent study of resistance, will be of vital importance since they will allow knowing real data from different regions of the country and will help to design programs adapted to each region and make them more efficient.

Our expectations are very high and having the support of OPGE in the organization and experience of the European Registry of H. pylori will be of great help to achieve a greater objective, which is to improve the quality of life of our population.”

Chili

“The truth is that the Hp LATAM Reg project comes to life from the generosity of Dr. Javier Gisbert and later, with the push of Dr. Leticia Moreira, current coordinator of the European project, who have had the vision of the importance of expanding the development of registries in other continents. Due to the idiopathic closeness and the friendship that has been generated over the years with Spanish researchers from the Spanish Association of Gastroenterology (AEG), we have been able to materialize the development of this project, which starts in Chile with 100 recruited patients, where the high response rate to quadruple scheme with high doses of proton pump inhibitors, amoxicillin and metronidazole associated with bismuth subsalicylate (97% efficacy), compared to schemes based on clarithromycin (In Santiago de Chile, resistance to clarithromycin is 30%). This type of experience can be disseminated and shared with other Latin American countries to improve our clinical practices. This project is of low complexity and can help us create a research culture so that in the future we can develop other more ambitious collaborative projects such as the study of resistance to antibiotics (Hp RESLA), under OPGE, since we have excellent researchers on the continent and the next president of OPGE is Dr. Alejandro Piscoya from Peru, so we can create a long-term agenda that allows us to generate new knowledge from the continent. We hope to have preliminary results to be presented at the Pan American Digestive Disease Weeks (SPED) between October 8 and 11, 2023 in Santiago, Chile.”