The prevalence of Helicobacter pylori remains high in the older population. Specific age-related peculiarities may impact the outcomes of H. pylori treatment. The aim of the study was to evaluate the diagnostics and effectiveness of H. pylori eradication between the younger and older European populations. "European Registry on H. pylori Management (Hp-EuReg)" data from 2013 to 2022 were analyzed. Patients were divided into older (≥ 60 years) and younger (18-59 years) groups. Modified intention-to-treat (mITT) and per-protocol (PP) analysis was performed. 49,461 patients included of which 14,467 (29%) were older-aged. Concomitant medications and penicillin allergy were more frequent among the older patients. Differences between younger and older populations were observed in treatment duration in first-line treatment and in proton pump inhibitors (PPIs) doses in second-line treatment. The overall incidence of adverse events was lower in the older adults group. The overall first-line treatment mITT effectiveness was 88% in younger and 90% in the older patients (p < 0.05). The overall second-line mITT treatment effectiveness was 84% in both groups. The effectiveness of the most frequent first- and second-line triple therapies was suboptimal (< 90%) in both groups. Optimal efficacy (≥ 90%) was achieved by using bismuth and non-bismuth-based quadruple therapies. In conclusion, the approach to the diagnostics and treatment of H. pylori infection did not generally differ between younger and older patients. Main differences were reported in the concurrent medications, allergy to penicillin and adverse events both in first- and second-line treatment. Optimal effectiveness rates were mostly achieved by using bismuth and non-bismuth-based quadruple therapies. No clinically relevant differences in the effectiveness between the age groups were observed.

2nd Department of Internal Medicine and Gastroenterology University Hospital and Charles University Faculty of Medicine in Hradec Králové 500 03 Hradec Králové Czech Republic

A 1 Yevdokimov Moscow State University of Medicine and Dentistry 127473 Moscow Russia

Agencia Sanitaria Costa del Sol Red de Investigación en Servicios de Salud en Enfermedades Crónicas 29651 Marbella Spain

Department of Gastroenterology A S Loginov Moscow Clinical Scientific Center 111123 Moscow Russia

Department of Gastroenterology Aberdeen Royal Infirmary Aberdeen AB25 2ZN UK

Department of Gastroenterology AM DC Rogaska 3250 Rogaska Slatina Slovenia

Department of Gastroenterology Centro Hospitalar do Porto Institute of Biomedical Sciences Abel Salazar Centro de Investigação em Tecnologias e Serviços de Saúde University of Porto 4050 313 Porto Portugal

Department of Gastroenterology CHRU de Nantes Hôpital Hôtel Dieu 44000 Nantes France

Department of Gastroenterology Clinical Center of Serbia University of Belgrade School of Medicine 11000 Belgrade Serbia

Department of Gastroenterology Digestive Diseases Centre Gastro Institute of Clinical and Preventive Medicine and Faculty of Medicine University of Latvia Riga 1079 Latvia

Department of Gastroenterology Ferencváros Health Centre 1095 Budapest Hungary

Department of Gastroenterology Gastrocentre 614068 Perm Russia

Department of Gastroenterology Henry Dunant Hospital 115 26 Athens Greece

Department of Gastroenterology Hospital Clínic Barcelona Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas University of Barcelona 08036 Barcelona Spain

Department of Gastroenterology Hospital de Valme 41014 Seville Spain

Department of Gastroenterology Hospital General de Tomelloso 13700 Tomelloso Spain

Department of Gastroenterology Interni Oddelek Diagnostic Centre 4260 Bled Slovenia

Department of Gastroenterology Lithuanian University of Health Sciences 50161 Kaunas Lithuania

Department of Gastroenterology Meander Medical Center 3813 TZ Amersfoort The Netherlands

Department of Gastroenterology Medical Microbiology Medical University of Sofia 1431 Sofia Bulgaria

Department of Gastroenterology Østfold Hospital Trust 1714 Grålum Norway

Department of Gastroenterology Otto Von Guericke University 39120 Magdeburg Germany

Department of Gastroenterology Pomeranian Medical University 70 204 Szczecin Poland

Department of Gastroenterology University Hospital of Split University of Split School of Medicine 21000 Split Croatia

Department of Surgical and Medical Sciences IRCCS AOUBO University of Bologna 40138 Bologna Italy

Division of Gastroenterology and Hepatology Hacettepe University School of Medicine 06230 Ankara Turkey

Division of Gastroenterology and Hepatology Medical University Department Kantonsspital Aarau 5001 Aarau Switzerland

Division of Gastroenterology Rabin Medical Center Sackler School of Medicine Tel Aviv University 49100 Tel Aviv Israel

Faculty of Health Sciences Trinity College Dublin Dublin D02PN40 Ireland

Gastroenterology Unit Hospital Universitario Central de Asturias 33011 Oviedo Spain

Gastroenterology Unit Hospital Universitario de La Princesa Instituto de Investigación Sanitaria Princesa Diego de León 62 28006 Madrid Spain

GOES Research Group Althaia Xarxa Assistencial Universitària de Manresa 08243 Manresa Spain

Government Institution L T Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine Kyiv Ukraine

Hospital Donostia Instituto Biodonostia Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas 20018 San Sebastián Spain

IIS Aragón y Facultad de Medicina de la Universidad de Zaragoza 50009 Zaragoza Spain

INSERM U1312 Université de Bordeaux 33000 Bordeaux France

Medicina Interna Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico Università Cattolica del Sacro Cuore 00168 Rome Italy

Memorial Klinik 1096 Baku Azerbaijan

Modern Hospital 1119 Baku Azerbaijan

Tver State Medical University 170100 Tver Russia

Sci Rep. 2023 Nov 1;13(1):18821. doi: 10.1038/s41598-023-45888-5. PubMed

See more in PubMed

Toh JWT, Wilson RB. Pathways of gastric carcinogenesis, Helicobacter pylori virulence and interactions with antioxidant systems, vitamin C and phytochemicals. Int. J. Mol. Sci. 2020;21(17):6451. doi: 10.3390/ijms21176451. PubMed DOI PMC

Kusters JG, van Vliet AHM, Kuipers EJ. Pathogenesis of Helicobacter pylori infection. Clin. Microbiol. Rev. 2006;19(3):449–490. doi: 10.1128/CMR.00054-05. PubMed DOI PMC

Guevara B, Cogdill AG. Helicobacter pylori: A review of current diagnostic and management strategies. Dig. Dis. Sci. 2020;65(7):1917–1931. doi: 10.1007/s10620-020-06193-7. PubMed DOI

Malfertheiner P, Megraud F, Rokkas T, Gisbert JP, Liou J-M, Schulz C, et al. Management of Helicobacter pylori infection: The Maastricht VI/Florence consensus report. Gut. 2022 doi: 10.1136/gutjnl-2022-327745. PubMed DOI

Jonaityte IR, Ciupkeviciene E, Jonaitis P, Kupcinskas J, Petkeviciene J, Jonaitis L. Changes in the seroprevalence of Helicobacter pylori among the Lithuanian medical students over the last 25 years and its relation to dyspeptic symptoms. Medicina. 2021;57:254. doi: 10.3390/medicina57030254. PubMed DOI PMC

Rowland M. The continuing decline in the prevalence of Helicobacter pylori infection. Lancet Child Adolesc. Health. 2022;6(3):139–140. doi: 10.1016/S2352-4642(22)00026-8. PubMed DOI

Park JS, Jun JS, Seo J-H, Youn H-S, Rhee K-H. Changing prevalence of Helicobacter pylori infection in children and adolescents. Clin. Exp. Pediatr. 2021;64(1):21–25. doi: 10.3345/cep.2019.01543. PubMed DOI PMC

Hooi JKY, Lai WY, Ng WK, Suen MMY, Underwood FE, Tanyingoh D, et al. Global prevalence of Helicobacter pylori infection: Systematic review and meta-analysis. Gastroenterology. 2017;153(2):420–429. doi: 10.1053/j.gastro.2017.04.022. PubMed DOI

Roberts SE, Morrison-Rees S, Samuel DG, Thorne K, Akbari A, Williams JG. Review article: The prevalence of Helicobacter pylori and the incidence of gastric cancer across Europe. Aliment Pharmacol. Ther. 2016;43(3):334–345. doi: 10.1111/apt.13474. PubMed DOI

Blanchard TG, Czinn SJ. Helicobacter pylori acquisition and transmission: Where does it all begin? Gastroenterology. 2001;121:483–485. doi: 10.1053/gast.2001.26769. PubMed DOI

Gisbert JP. The recurrence of Helicobacter pylori infection: Incidence and variables influencing it. A critical review. Am. J. Gastroenterol. 2005;100(9):2083–2099. doi: 10.1111/j.1572-0241.2005.50043.x. PubMed DOI

Kanasi E, Ayilavarapu S, Jones J. The aging population: Demographics and the biology of aging. Periodontology 2000. 2016;72(1):13–18. doi: 10.1111/prd.12126. PubMed DOI

De Luca DE, Bonacci S, Giraldi G. Aging populations: The health and quality of life of the elderly. Clin. Ter. 2011;162(1):e13–e18. PubMed

Huang Q, Jia X, Chu Y, Zhang X, Ye H. Helicobacter pylori infection in geriatric patients: Current situation and treatment regimens. Front. Med. 2021;8:713908. doi: 10.3389/fmed.2021.713908. PubMed DOI PMC

Pilotto A, Franceschi M. Helicobacter pylori infection in older people. World J. Gastroenterol. 2014;20(21):6364–6373. doi: 10.3748/wjg.v20.i21.6364. PubMed DOI PMC

Shruthi R, Jyothi R, Pundarikaksha HP, Nagesh GN, Tushar TJ. A study of medication compliance in geriatric patients with chronic illnesses at a tertiary care hospital. J. Clin. Diagn. Res. 2016;10(12):FC40–FC43. PubMed PMC

Klotz U. Pharmacokinetics and drug metabolism in the elderly. Drug Metab. Rev. 2009;41(2):67–76. doi: 10.1080/03602530902722679. PubMed DOI

van Beek JHGM, Kirkwood TBL, Bassingthwaighte JB. Understanding the physiology of the ageing individual: Computational modelling of changes in metabolism and endurance. Interface Focus. 2016;6(2):20150079. doi: 10.1098/rsfs.2015.0079. PubMed DOI PMC

Malfertheiner P, Megraud F, O’Morain CA, Gisbert JP, Kuipers EJ, Axon AT, et al. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut. 2017;66(1):6–30. doi: 10.1136/gutjnl-2016-312288. PubMed DOI

Liou J-M, Lin J-T, Lee Y-C, Wu C-Y, Wu M-S. Helicobacter pylori infection in the elderly. Int. J. Gerontol. 2008;2(4):145–153. doi: 10.1016/S1873-9598(09)70002-X. DOI

Kobayashi S, Joshita S, Yamamoto C, Yanagisawa T, Miyazawa T, Miyazawa M, et al. Efficacy and safety of eradication therapy for elderly patients with Helicobacter pylori infection. Medicine. 2019;98(30):e16619. doi: 10.1097/MD.0000000000016619. PubMed DOI PMC

Gao C, Fan Y-H. Effect and safety of Helicobacter pylori eradication treatment based on molecular pathologic antibiotic resistance in Chinese elderly people. Infect. Drug Resist. 2022;15:3277–3286. doi: 10.2147/IDR.S371113. PubMed DOI PMC

Megraud F, Bruyndonckx R, Coenen S, Wittkop L, Huang T-D, Hoebeke M, et al. Helicobacter pylori resistance to antibiotics in Europe in 2018 and its relationship to antibiotic consumption in the community. Gut. 2021;70(10):1815–1822. doi: 10.1136/gutjnl-2021-324032. PubMed DOI

Denkinger CM, Grant AD, Denkinger M, Gautam S, D’Agata EMC. Increased multi-drug resistance among the elderly on admission to the hospital—a 12-year surveillance study. Arch. Gerontol. Geriatr. 2013;56(1):227–230. doi: 10.1016/j.archger.2012.05.006. PubMed DOI

Hujer AM, Bethel CR, Hujer KM, Bonomo RA. Antibiotic resistance in the institutionalized elderly. Clin. Lab. Med. 2004;24(2):343–361. doi: 10.1016/j.cll.2004.03.005. PubMed DOI

Jiang F, Guo C-G, Cheung KS, Li B, Law SYK, Leung WK. Age of eradication and failure rates of clarithromycin-containing triple therapy for Helicobacter pylori: A 15-year population-based study. Helicobacter. 2022;27(3):e12893. doi: 10.1111/hel.12893. PubMed DOI

McNicholl AG, O’Morain CA, Megraud F, Gisbert JP. Protocol of the European Registry on the management of Helicobacter pylori infection (Hp-EuReg) Helicobacter. 2019;24(5):e12630. doi: 10.1111/hel.12630. PubMed DOI

WHO. Ageing and Health by World Health Organization. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health (Accessed 15 Aug 2022).

UN. Older persons by United Nations. https://emergency.unhcr.org/entry/43935/older-persons. An older person is defined, or age-related health conditions (Accessed 15 Aug 2022).

Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed. Inform. 2009;42(2):377–381. doi: 10.1016/j.jbi.2008.08.010. PubMed DOI PMC

Graham DY, Lu H, Dore MP. Relative potency of proton-pump inhibitors, Helicobacter pylori therapy cure rates, and meaning of double-dose PPI. Helicobacter. 2019;24(1):e12554. doi: 10.1111/hel.12554. PubMed DOI PMC

Kirchheiner J, Glatt S, Fuhr U, Klotz U, Meineke I, Seufferlein T, et al. Relative potency of proton-pump inhibitors-comparison of effects on intragastric pH. Eur. J. Clin. Pharmacol. 2009;65(1):19–31. doi: 10.1007/s00228-008-0576-5. PubMed DOI

Jin J, Sklar GE, Min Sen OhV, Chuen LS. Factors affecting therapeutic compliance: A review from the patient’s perspective. Ther. Clin. Risk Manag. 2008;4(1):269–286. PubMed PMC

Jimmy B, Jose J. Patient medication adherence: Measures in daily practice. Oman Med. J. 2011;26(3):155–159. doi: 10.5001/omj.2011.38. PubMed DOI PMC

McNicholl AG, Bordin DS, Lucendo A, Fadeenko G, Fernandez MC, Voynovan I, et al. Combination of bismuth and standard triple therapy eradicates Helicobacter pylori infection in more than 90% of patients. Clin. Gastroenterol. Hepatol. Off. Clin. Pract. J. Am. Gastroenterol. Assoc. 2020;18(1):89–98. PubMed

Nyssen OP, Perez-Aisa A, Castro-Fernandez M, Pellicano R, Huguet JM, Rodrigo L, et al. European Registry on Helicobacter pylori management: Single-capsule bismuth quadruple therapy is effective in real-world clinical practice. United Eur. Gastroenterol. J. 2021;9(1):38–46. doi: 10.1177/2050640620972615. PubMed DOI PMC

Nyssen OP, Bordin D, Tepes B, Pérez-Aisa Á, Vaira D, Caldas M, et al. European Registry on Helicobacter pylori Management (Hp-EuReg): Patterns and trends in first-line empirical eradication prescription and outcomes of 5 years and 21 533 patients. Gut. 2021;70(1):LP40–LP54. doi: 10.1136/gutjnl-2020-321372. PubMed DOI

Nyssen OP, Vaira D, Tepes B, Kupcinskas L, Bordin D, Pérez-Aisa Á, et al. Room for improvement in the treatment of Helicobacter pylori infection: Lessons from the European Registry on H. pylori Management (Hp-EuReg) J. Clin. Gastroenterol. 2022;56(2):e98–108. doi: 10.1097/MCG.0000000000001482. PubMed DOI

Nyssen OP, Moreira L, García-Morales N, Cano-Català A, Puig I, Mégraud F, et al. European Registry on Helicobacter pylori Management (Hp-EuReg): Most relevant results for clinical practice. Front. Gastroenterol. 2022 doi: 10.3389/fgstr.2022.965982. DOI

Zullo A, Fiorini G, Scaccianoce G, Portincasa P, De Francesco V, Vassallo R, et al. Sequential therapy for first-line Helicobacter pylori eradication: 10- or 14-day regimen? J. Gastrointestin. Liver Dis. 2019;28(1):11–14. doi: 10.15403/jgld.2014.1121.281.hpy. PubMed DOI

Tursi A, Franceschi M, Allegretta L, Savarino E, De Bastiani R, Elisei W, et al. Effectiveness and safety of Pylera® in patients infected by Helicobacter pylori: A multicenter, retrospective, real life study. Dig. Dis. 2018;36(4):264–268. doi: 10.1159/000487391. PubMed DOI

Sun Q, Liang X, Zheng Q, Liu W, Xiao S, Gu W, et al. High efficacy of 14-day triple therapy-based, bismuth-containing quadruple therapy for initial Helicobacter pylori eradication. Helicobacter. 2010;15(3):233–238. doi: 10.1111/j.1523-5378.2010.00758.x. PubMed DOI

Sukri A, Lopes BS, Hanafiah A. The emergence of multidrug-resistant Helicobacter pylori in Southeast Asia: A systematic review on the trends and intervention strategies using antimicrobial peptides. Antibiotiotics. 2021;10(9):1061. doi: 10.3390/antibiotics10091061. PubMed DOI PMC

Hulten KG, Lamberth LB, Kalfus IN, Graham DY. National and regional US antibiotic resistance to Helicobacter pylori: Lessons from a clinical trial. Gastroenterology. 2021;161(1):342–344.e1. doi: 10.1053/j.gastro.2021.03.045. PubMed DOI PMC