EMPIRICAL RESCUE THERAPY FOR HELICOBACTER PYLORI INFECTION: DATA FROM THE ITALIAN REGISTRY ON HELICOBACTER PYLORI TREATMENT (HP-ITAREG)

Aims/Purpose: We aimed to assess the patterns and effectiveness of empirical rescue treatment of Helicobacter (H.) pylori infection in clinical practice in Italy. Methods: The “Italian Registry on H. pylori treatment” (Hp-ItaReg) is a prospective, multicenter study that registers adult patients who have received at least one H. pylori treatment in 18 centers in Italy. All patients who failed at least two empirical eradication attempts were assessed for effectiveness using modified intention-to-treat (mITT) and per-protocol (PP) analyses. Results: A total of 502 patients received an empirical rescue therapy. Of these, 205 (41%) received single-capsule bismuth quadruple therapy (BQT), 132 (26%) rifabutin and amoxicillin triple therapy, 69 (14%) levofloxacin and amoxicillin triple therapy, 27 (5%) sequential therapy, and 69 (14%) other regimens. 51 patients were lost to follow-up; thus, 451 patients were included in the mITT analysis and 439 in the PP analysis. According to mITT and PP analyses, eradication rates were 83.1% (157/189) and 85.1% (154/ 181) with single-capsule BQT therapy, 65.5% (76/116) and 65.8% (75/114) with rifabutin and amoxicillin triple therapy, 65% (39/60) and 65% (39/60) with levofloxacin and amoxicillin triple therapy, 45.5% (10/22) and 47.6% (10/21) with sequential therapy, and 72.3% (44/64) and 69.8% (44/63) with other regimens. Conclusion: Single-capsule BQT and triple therapy with rifabutin and amoxicillin are the regimens most frequently prescribed for the rescue treatment of H. pylori in Italy. Single-capsule BQT provided acceptable eradication rates, while other regimens yielded eradication rates >70%.