The OPGE supports the Latin American Registry of Helicobacter pylori (HP-Latam Reg)

The Worldwide Registry on the Management of Helicobacter Pylori Infection (WorldHpReg) is the union of multiple international prospective multicenter registries on the management of Helicobacter pylori infection and its treatment in the clinical practice of gastroenterologists.

WorldHpReg was born in 2021 under the impetus of the European Registry on Helicobacter pylori Management (Hp-EuReg) and currently has the participation of the regions of Latin America, Africa, Australia, Canada, the Association of Southeast Asian Nations, the United States, Pakistan, Saudi Arabia, India, Jordan and New Zealand.
What is the objective of WorldHpReg?

The great diversity of treatment regimens and lines for the eradication of Helicobacter pylori and their different effectiveness, due above all to the increase in bacterial antibiotic resistance and regional differences, requires a continuous critical analysis of clinical practice, systematically evaluating the efficacy and safety of the various regimens and the cost-effectiveness of the different diagnostic-therapeutic strategies.

A Global Registry on the management of H. pylori can help design effective and optimized treatments that reduce the number of retreatments, diagnostic tests and the appearance of associated pathologies such as peptic ulcers and gastric cancers. Therefore, the evaluation of real clinical practice through non-interventional registries can help to improve the design and organization of a Consensus on the management of H. pylori infection in each territory.

Generally, there is a delay from the publication of the recommendations until their implementation in routine clinical practice, sometimes reaching full penetration after they have become obsolete. It is essential to carry out prospective studies, in real life, that allow us to create tools capable of providing data to evaluate the practice and trends of the results initially obtained at a local, regional and global level.

The main objective of WorldHpReg is to obtain a database that systematically records a large and representative sample of the usual clinical practice of gastroenterologists in each territory to produce descriptive studies on the management of H pylori infection. With the epidemiological data obtained, better therapeutic strategies can be designed according to the evidence, the available drugs and the accessibility to health technologies of each reality.

HP-LATAMReg (@hplatamreg)
The Hp-LATAMReg is the registry of the practice of Latin American gastroenterologists in the management of Helicobacter pylori infection and its treatment.
The Hp-LATAMReg is an initiative of the Chilean Society of Gastroenterology and the Pan American Organization of Gastroenterology (OPGE).
The Latin American registry is growing day by day, as of April 24, 2023 it had 2,497 patients.

 

List of managers, centers and countries registered in the Hp-LATAMReg until the time of publication.

 

MEXICO
• Remes-Troche, Jose Maria. Veracruzana University, Veracruz, Mexico.
• González Huezo, Maria Saraí. Social Security Institute of the State of Mexico and Municipalities, Toluca, Mexico.
• Bosques Padilla, Francisco Javier. Tecnológico de Monterrey, Monterrey, Nuevo León, Mexico.
• Coss Adame, Enrique. Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, Mexico.
• Velarde Ruiz Velasco, José Antonio. Guadalajara Civil Hospital, Guadalajara, Jalisco, Mexico.
• La Tijera Fig Tree, Fátima. General Hospital of Mexico Dr. Eduardo Liceaga, Mexico City, Mexico City, Mexico.
• Raña-Garibay, Ricardo. Spanish Hospital of Mexico, Mexico City, Mexico.
• Flores Rendon, Ricardo. Baja California Institute of Security and Social Services of Government Workers and Municipalities of the State of Baja California, Tijuana, Mexico.
• Gómez-Escudero, Octavio. Angeles Puebla Hospital, Puebla, Mexico.
• Yamamoto Furusho, Jesus. Medical Sur Hospital, Mexico City, Mexico.
• Valdes, Eumir Israel Juárez. Hospital Juárez de México, Mexico City, Mexico.
• Ortiz-Olvera, Nayeli X. UMAE CMN Sigle XXI IMSS, Mexico City, Mexico.

PERU
• Piscoya-Rivera, Alejandro. Guillermo Kaelin de la Fuente Hospital, Lima, Peru.
• Ramírez García, Juan. Liga Contra el Cancer Clinic, Lima, Peru.
• Cedrón-Cheng, Hugo Guillermo. Anglo American Clinic, Lima, Peru.
• Cabrera Hinojosa, Dacio Héctor. Dos de Mayo National Hospital, Lima, Peru.
• Otoya, Guillermo. Guillermo Almenara Irigoyen Hospital, Lima, Peru.

CHILI
• Riquelme, Arnoldo. Reyes-Placencia, Diego. Vargas, César. Medel-Jara, Patricio. Latorre, Gonzalo. Chahuán, Javier. Pizarro, Margarita. Binder, María Victoria. Bustamante, Miguel. Dukes, Eitan. Martínez, Francisca. Silva, Felipe. Candia, Roberto. Vargas Domínguez, José Ignacio. Gastroenterology, Pontifical Catholic University of Chile, Santiago, Chile.
• Von Muhlenbrock, Christian. Universidad de los Andes Clinic, Las Condes, Sant Metropolitan Region, Chile.
• Arenas, Alex. Clínica Alemana de Santiago SA, Vitacura, Metropolitan Region, Chile.
• Mansilla Vivar, Rodrigo. Puerto Montt Hospital, Puerto Montt, Llanquihue, Chile.

ARGENTINA
• Laudanno, Oscar. Doctor Alfredo Lanari Institute, Buenos Aires, Argentina.
• Ahumaran, Gabriel. Monte Grande Clinic, Buenos Aires, Argentina.
• Rodríguez, Pablo César. Córdoba Model Institute, Córdoba, Argentina.
• Bedini, Oscar Alfredo. Digestive Endoscopy Center, Rosario, Argentina.
• Ustares, Fernando. Lavalle Sanatorium, Jujuy, Argentina.

COLOMBIA
• Otero, William. Marulanda, Hernando. National University of Colombia, Bogotá, Colombia.
• Otero, Lina. Otero, Elder. Gastroenterology and Endoscopy Center, Bogotá, Colombia.
• Trespalacios, Alba. Pontifical Javeriana University, Bogotá, Colombia.

COSTA RICA
• Campos Nuñez, Christian. Hospital Clínica Biblica, San José, Costa Rica.

ECUADOR
• Hanna-Jairala, Ignacio. Miguel H Alcívar Hospital, Guayaquil, Guayas, Ecuador.

SPAIN
• Gisbert, Javier P., Nyssen, Olga P., Parra, Pablo. La Princesa University Hospital, Madrid, Spain.
• Cano-Català, Anna. GOES research group, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa. Institute for Research and Innovation in Life and Health Sciences of Central Catalonia (IRIS-CC), Vic, Spain.
• Moreira, Leticia. Hospital Clínic de Barcelona, ​​Barcelona, ​​Catalunya, Spain.

 

 

The Hp-LATAMReg is an open registry for all those who wish to participate in the different countries of Latin America.

If you want to know the requirements, you must contact Dr. Diego Reyes-Plasencia (dmreyes@uc.cl).

 

 

Hp-LATAMReg PRODUCT PUBLICATIONS UNTIL MAY 2024.

 

1. First description of the data from the Latin American Registry on the management of Helicobacter pylori infection (Hp-LATAMReg).
Presented at the European Helicobacter and Microbiota Study Group during the 36th International Workshop on Helicobacter & Microbiota in Inflammation & Cancer. Antwerp, Beligium. Set. 2023.

Objective: There is limited information regarding the best approach for Helicobacter pylori management in Latin America. Our aim was to describe the main characteristics of the H. pylori eradication treatment in Latin America.
Materials and Methods: A multicenter, prospective, international registry (Hp-LATAMReg) was conducted. Information about therapies used by gastroenterologists in five countries (Chile, Argentina, Mexico, Peru, and Colombia) from 2015 to 2023 was registered in an e-CRF AEG-REDCap database. The modified intention-to-treat (mITT) effectiveness, safety, and adherence was analyzed for the first-line regimens. Data were quality reviewed.

Results: We registered 681 patients, of which 599 (88%) were treatment-naïve. The most frequent indication for treatment was dyspepsia (n=443, 65%). The most commonly prescribed first-line therapies were: proton pump inhibitor (PPI)-amoxicillin (A)-clarithromycin (C), PPI-C-A-Metronidazole (M), PPI-A, PPI-C-A-Bismuth (B) and PPI -A-Levofloxacin (L). Most of the regimens were 14-day long (n=546.93%), and administered low-dose PPIs (n=282, 47%). The first-line mITT overall effectiveness ranged from 80% to 91%, and PPI+C+A+M was the only regimen that achieved over 90% eradication (Table). The incidence of at least one adverse event was 35%, the most common being abdominal pain (17%).
Acceptable adherence, defined as >90% of drug intake, was observed in 97%.

Conclusions: In Latin America, optimal (>90%) effectiveness was only obtained with 14-day concomitant non-bismuth quadruple therapy (PPI-C-A-M). Triple therapies and low-dose PPIs are still commonly prescribed, leaving room for improvement.

 

2. Helicobacter pylori diagnostic tests and indications of treatment from the Latin American registry on the management of Helicobacter pylori infection (Hp-LATAMReg)

Presented for the Pan American Gastroenterology Week. Chile 2023.
Published in the Journal of Gastroenterology of Peru. Abstract S95.
DOI: https://doi.org/10.47892/rgp.2023.43Supl1.1616

Background: There is limited information regarding the best approach for Helicobacter pylori (H.pylori) management in Latin America.

Objectives: Describes the H. pylori diagnostic tests and indications of treatment in Latin America.
Methods: A multicenter, retrospective, international registry (Hp-LATAMReg) was conducted. Information about therapies used by gastroenterologists in six countries (Argentina, Chile, Colombia, Costa Rica, Mexico, and Peru) from 2015 to 2023 was registered in an e-CRF AEG-REDCap database. The most frequent indications for treatment and diagnostic tests before and after eradication treatment were described.

Results: 1,378 patients were registered, of which 933 (68%) were female. The mean (SD) age of the patients was 53 (14) years. 524 patients (38%) were from Mexico, 210 patients (15%) from Argentina, 210 (15%) from Chile, 200 (14%) from Colombia, 176 (13%) from Peru and 58 (4.2%) from Costa Delicious. 1218 (89%) were treatment naïve. The most frequent indication for treatment were non-investigated dyspepsia (n=526, 38%) and dyspepsia with normal endoscopy (n=334, 24%). The main H. pylori diagnostic methods before the eradication treatment were: histology (n=905, 67%), rapid urease test (RUT) (n=196, 14%) and 13C urea breath test (UBT) (n=180, 13%). To assess post-treatment eradication, the most frequent H. pylori diagnostics test used were: stool antigen (SA) monoclonal test (n=530, 39%), 13C UBT (n=400, 29%) and 14C UBT (n= 215, 16%). There were statistical differences between the countries regarding the indication for treatment and the diagnostics methods before and after the eradication therapy (Table 1).

Conclusions: In Latin America, there was marked heterogeneity between the countries regarding the main indications of treatment and the most frequently used diagnostics tests for H. pylori infection. It is necessary a consensus on the management of H. pylori infection in Latin America.

 

3. Abstract presented for UEGW 2024.

Background: Helicobacter pylori infection is a public health problem in Latin America. The aim was to describe the main Helicobacter pylori eradication therapies, their eradication rates, adherence, side effects, proton pump inhibitor (PPI) potency and length of treatment.

Methods: A multicenter, prospective, international registry (Hp-LATAMReg) was conducted. Information about therapies used by gastroenterologists in seven countries (Argentina, Chile, Colombia, Costa Rica, Ecuador, Mexico, and Peru) from 2015 to 2024 was registered in an e-CRF AEG-REDCap database. The modified intention-to-treat (mITT) effectiveness, safety, and adherence was analyzed for the first-line regimens. The length of the treatment and the proton pump inhibitor (PPI) dose were analyzed too.

+Results: 2,511 patients were registered, of which 2,323 (93%) were treatment-naïve. The most commonly prescribed first-line therapies (n=2,163, 86%) were analyzed: standard clarithromycin-based triple therapy (SCTT) (PPI-amoxicillin (A)-clarithromycin (C); n=771, 29%), PPI -C-A-Metronidazole (M) (n=362, 14%), dual therapy (DT) (PPI-A; n=274, 11%), PPI-M-Doxycycline (D)-B (n=198,7.9 %), PPI-M-Tetracycline (Tc)-Bismuth (B) (n=184, 7.3%), PPI-A-M-B (n=156,6.2%), PPI-C-A-B (n=113, 4.5%), and PPI-A-Levofloxacin (L) (n=105, 4.2%).
The first-line mITT overall effectiveness ranged from 73% to 95%, with the PPI-A-M-B and PPI-C-A-M being the only therapies which had an eradication rate of more than 90%. The DT had the lowest rate of side effects with a 7.3% (n=20).
The highest rate of side effects was from the PPI-M-D-B (48%, n=95). Good adherence, defined as >90% of drug intake, was observed in 85% (n=2,124), most of the regimens were 14-day long (n=2,028, 81%) and administered high-dose PPIs (54 to 128 mg omeprazole equivalents b.i.d.) (n=1,355, 54%) with differences between the schemes in those characteristics (p<0.01) (Table 1).

Conclusions: In Latin America, quadruple therapies were the only therapies which had an effectiveness above 90%. DT had the lowest side effects rate with an acceptable eradication rate. SCTT had an unacceptable eradication rate and a high side effects rate but was still the therapy most frequently used in Latin America.

 

 

Table 1. Eradication rate, side effects rate, acceptable adherence rates, high PPI potency and length of the treatment of the different schemes. *Chi square test. mITT = modified intention to treat; SCTT = Standard clarithromycin-based triple therapy; DT = Dual therapy; PPI = Proton pump inhibitor; C = Clarithromycin; A = Amoxicillin; B = Bismuth salts; M = Metronidazole; L = Levofloxacin; T = Tetracycline; D = Doxycycline.

 

4. Posters presented at DDW Washington 2024