The segmentation of patients into homogeneous groups could help to improve eradication therapy effectiveness. Our aim was to determine the most important treatment strategies used in Europe, to evaluate first-line treatment effectiveness according to year and country. Data collection: All first-line empirical treatments registered at AEGREDCap in the European Registry on Helicobacter pylori management (Hp-EuReg) from June 2013 to November 2022. A Boruta method determined the "most important" variables related to treatment effectiveness. Data clustering was performed through multi-correspondence analysis of the resulting six most important variables for every year in the 2013-2022 period. Based on 35,852 patients, the average overall treatment effectiveness increased from 87% in 2013 to 93% in 2022. The lowest effectiveness (80%) was obtained in 2016 in cluster #3 encompassing Slovenia, Lithuania, Latvia, and Russia, treated with 7-day triple therapy with amoxicillin-clarithromycin (92% of cases). The highest effectiveness (95%) was achieved in 2022, mostly in Spain (81%), with the bismuth-quadruple therapy, including the single-capsule (64%) and the concomitant treatment with clarithromycin-amoxicillin-metronidazole/tinidazole (34%) with 10 (69%) and 14 (32%) days. Cluster analysis allowed for the identification of patients in homogeneous treatment groups assessing the effectiveness of different first-line treatments depending on therapy scheme, adherence, country, and prescription year.

Adelson Faculty of Medicine Ariel University Ariel 4070000 Israel

Cardiovascular Internal Medicine IRCCS Azienda Ospedaliero Universitaria di Bologna 40138 Bologna Italy

Center for Research in Health Technologies and Information Systems 4200 450 Porto Portugal

Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas 28029 Madrid Spain

Consejo Nacional de Investigaciones Científicas y Técnicas Ciudad Autónoma de Buenos Aires C1425FQB Argentina

Departamento de Medicina Universidad Autónoma de Madrid 28049 Madrid Spain

Department of Digestive Disorders Aberdeen Royal Infirmary Aberdeen AB25 2ZN UK

Department of Gastroenterology and Digestive Endoscopy Masaryk Memorial Cancer Institute 656 53 Brno Czech Republic

Department of Gastroenterology and Hepatology CHU de Charleroi 6042 Charleroi Belgium

Department of Gastroenterology and Hepatology Meander Medical Center 3813 Amersfoort The Netherlands

Department of Gastroenterology Biodonostia Health Research Institute 20014 San Sebastián Spain

Department of Gastroenterology DC Rogaska 3250 Rogaska Slatina Slovenia

Department of Gastroenterology Digestive Diseases Centre LV 1006 Riga Latvia

Department of Gastroenterology HC International Clinic Hacettepe University 06690 Ankara Turkey

Department of Gastroenterology Hepatology and Infectious Diseases University Hospital of Magdeburg 39120 Magdeburg Germany

Department of Gastroenterology Hospital Universitario de Valme 41014 Seville Spain

Department of Gastroenterology Østfold Hospital Trust 1714 Grålum Norway

Department of Gastroenterology Pomeranian Medical University 70 204 Szczecin Poland

Department of Gastroenterology University Clinic for Gastroenterohepatology 1000 Skopje North Macedonia

Department of Gastroenterology University Clinical Center of Serbia 11000 Belgrade Serbia

Department of Gastroenterology University Hospital of Split 21000 Split Croatia

Department of Gastroenterology University of Medicine Pharmacy Science and Technology of Târgu Mures 540142 Târgu Mures Romania

Department of Internal Medicine Gastroenterology and Geriatrics University Hospital Olomouc 779 00 Olomouc Czech Republic

Department of Medical Microbiology Medical University of Sofia 1431 Sofia Bulgaria

Department of Medicine Universidad del País Vasco 20014 San Sebastián Spain

Department of Outpatient Therapy and Family Medicine Tver State Medical University 170100 Tver Russia

Department of Pancreatic Biliary and Upper Digestive Tract Disorders A S Loginov Moscow Clinical Scientific Center 111123 Moscow Russia

Department of Propaedeutic of Internal Diseases and Gastroenterology A 1 Yevdokimov Moscow State University of Medicine and Dentistry 127473 Moscow Russia

Department of Surgery Transplantation and Gastroenterology Semmelweis University 1085 Budapest Hungary

Department of Surgery University Hospital Brno 625 00 Brno Czech Republic

Department of Surgical and Medical Sciences Sant'Orsola Malpighi University Hospital 40138 Bologna Italy

Departments the Division for the Study of the Digestive Diseases and Its Comorbidity with Noncommunicable Diseases Government Institution L T Malaya Therapy National Institute of NAMS of Ukraine 61039 Kharkiv Ukraine

Digestive System Service of the Hospital Universitario de La Princesa 28006 Madrid Spain

Dipartimento di Statistica e Metodi Quantitativi Universitá degli studi di Milano Bicocca 20126 Milano Italy

Division of Gastroenterology Rabin Medical Center Tel Aviv University Tel Aviv Yafo 49100 Israel

Faculty of Medicine and Dentistry Palacky University Olomouc 779 00 Olomouc Czech Republic

Faculty of Medicine Masaryk University 601 77 Brno Czech Republic

Faculty of Medicine Ss Cyril and Methodius University in Skopje 1000 Skopje North Macedonia

Faculty of Medicine University of Latvia LV 1004 Riga Latvia

Gastroenterology Clinic Henry Dunant Hospital 115 26 Athens Greece

Gastroenterology Department Centro Hospitalar do Porto 4150 001 Porto Portugal

Gastroenterology Department Kantonsspital Aarau 5001 Aarau Switzerland

Gastroenterology Unit Hospital Santos Reyes 09400 Aranda de Duero Spain

Gastrointestinal Oncology Endoscopy and Surgery Research Group Althaia Xarxa Assistencial Universitària de Manresa 08243 Barcelona Spain

Hepato Gastroenterology and Digestive Oncology Unit University Hospital of Nantes 44000 Nantes France

Hospital Clínic de Barcelona 08036 Barcelona Spain

Hospital Universitario Costa del Sol 29603 Marbella Spain

INSERM Institut National de la Santé Et de la Recherche Médicale U1312 Université de Bordeaux 33077 Bordeaux France

Institut d'Investigacions Biomèdiques August Pi i Sunyer University of Barcelona 08036 Barcelona Spain

Institut de Recerca i Innovació en Ciències de la Vida i de la Salut de la Catalunya Central 08500 Barcelona Spain

Institute for Digestive Research Department of Gastroenterology Lithuanian University of Health Sciences 44307 Kaunas Lithuania

Institute of Clinical and Preventive Medicine LV 1079 Riga Latvia

Instituto De Ciências Biomédicas de Abel Salazar Universidade do Porto 4050 313 Porto Portugal

Instituto de Investigación Sanitaria de Aragón 50009 Zaragoza Spain

Instituto de Investigación Sanitaria Princesa 28006 Madrid Spain

Medicina interna e Gastroenterologia Fondazione Policlinico Universitario Agostino Gemelli IRCCS 00168 Rome Italy

School of Medicine Trinity College Dublin D02 PN40 Dublin Ireland

School of Medicine University of Belgrade 11000 Belgrade Serbia

School of Medicine University of Split 21000 Split Croatia

Science and Technology and Department Universidad Nacional de Quilmes Bernal B1876 Argentina

Servicio de Aparato Digestivo Hospital Clínico Universitario Lozano Blesa 50009 Zaragoza Spain

Unidad de Análisis de Datos del Instituto de Investigación Sanitaria Princesa 28006 Madrid Spain

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