| Popis |
Introduction: The clinical scenarios in which probiotics (PB) are useful as adjuvants to Helicobacter pylori eradication therapy have not been well established. Aims & Methods: Aims: To determine the use and factors associated with the prescription of PB adjuvants to H pylori eradication regimens, by European gastroenterologists in clinical practice. Methods: Prospective, multicentre, non-interventional registry (HpEuReg) of the clinical practice of European gastroenterologists. Data were collected in an AEG-REDCap e-CRD from 2013 to 2022. All data from countries with at least 30 cases undergoing eradication therapy and at least 1 case with associated PB were included, using patients without PB as controls. Analysis was performed by geographic area. Results: A total of 36,699 patients were included, 8,233 (22%) with PB. Multiple PB formulations were used, including 9 genera and 32 species, the most frequent being Saccharomyces boulardii (2,315), Lactobacillus rhamnosus (1,897), Bifidobacterium breve (1,765), Lactobacillus reuteri (1,732) and Lactobacillus acidophilus (1,447). Forty-one percent of the formulations were multi-genus, 34% were symbiotic and 11% were combined with other products. As factors associated with prescribing, there was a higher rate of females in the PB group (64% vs 60%; p<0.0001), with similar age (49 vs 51). Patients in the PB group had a higher rate of resistance to clarithromycin (11.4 vs 1.4), metronidazole (10.7 vs 1.4) and dual (10.7 vs 1.4). In terms of line of eradication therapy, PB use was more frequent (p<0.0001) in patients in 5th (28%) and 6th line (46%) compared to 1st (22%), 2nd (23%), 3rd (24%) and 4th (24%). The rate of PB use varied between the different eradication regimens, being most frequent in sequential (74%), followed by hybrid (38%) and dual (33%). In contrast, the rate was lower in classic bismuth quadruple (24%), or the same in single capsule (21%), triple (17%) and non-bismuth quadruple (15%). The percentage of PB use per country ranged from 95% in Serbia to 0.2% in Slovenia. The central geographical area had by far the highest prescription rate (83%). The rates in the rest were 38% in the east, 9% in the southeast, 7% in the southwest and 1% in the north. We observed that the rate of adverse effects in the non-PB group was higher in the central area than in the other areas (38% vs. 28%; p<0.0001), suggesting that in areas with less PB use there may be a prescription of PBs driven by the expectation of adverse effects. Conclusion: The prescription of PB adjuvant to eradication therapy is very heterogeneous. There is greater use of PB associated with sequential, dual and hybrid therapies, patients with antibiotic resistance, advanced lines of treatment and women. In areas with lower PB use, there seems to be a prescription bias towards patients with a higher expected risk of adverse effects.
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