Lack of follow-up in Helicobacter pylori eradication treatment: Results from the European registry on Helicobacter pylori management

BACKGROUND The Maastricht VI/Florence consensus recommends the eradication of all Helicobacter pylori (H. pylori ) infections. However, retreatment strategies remain inconsistent. AIM To evaluate the reasons for and factors associated with non-retreatment after H. pylori eradication treatment failure. METHODS A multicenter, prospective registry (European registry on H. pylori management) was used to evaluate the decisions and outcomes of H. pylori management by European gastroenterologists. Patients with at least one eradication failure between 2013 and 2024 were included and classified into retreatment (control) and non-retreatment. The reasons for non-retreatment were categorized as medical- or patient-related. Multivariate logistic regression identified factors associated with non-retreatment from each perspective. RESULTS Of the 6904 patients with eradication failure, 950 (14%) were not retreated: 41% due to medical decisions, 50% due to patient decisions, and 9% due to other reasons. Frequent reasons for non-retreatment included previous poor tolerance, noncompliance, unclear indications, and multiple eradication attempts. From a medical perspective, non-retreatment was associated with age ≥ 71 years [odds ratio (OR) = 1.49; 95% confidence interval (CI): 1.04-2.13], previous noncompliance (OR = 4.27; 95%CI: 2.64-6.93), treatment discontinuation due to adverse events (OR = 2.06; 95%CI: 1.19-3.56), and number of previous attempts (OR range: 2.07-9.25). From the patient perspective, the associated factors included male sex (OR = 1.34; 95%CI: 1.10-1.63), two to four previous eradication attempts (OR range: 1.69-3.60) and previous noncompliance (OR = 10.04; 95%CI: 7.37-13.68). CONCLUSION Up to 14% of European patients are not retreated after H. pylori eradication failure. Key barriers include advanced age, previous noncompliance and prior eradication failures. The decision to avoid retreatment was often patient-driven, although medical reasons were also relevant, highlighting the importance of shared decision-making and improved patient education.