{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T02:53:21Z","timestamp":1782874401216,"version":"3.54.5"},"reference-count":45,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"vor","delay-in-days":43,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Helicobacter"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      The effectiveness of anti\n                      <jats:italic>\n                        \u2010\n                        <jats:styled-content style=\"fixed-case\">H.\u2009pylori<\/jats:styled-content>\n                      <\/jats:italic>\n                      treatment diminishes with therapy failure, making regional performance understanding crucial.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the effectiveness of empirical therapy in second\u2010line and subsequent treatments in Brazil.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A multicenter, prospective, noninterventional registry assessed\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>H.\u2009pylori<\/jats:italic>\n                      <\/jats:styled-content>\n                      management outcomes by Brazilian gastroenterologists (Hp\u2010BrazilRe, Hp\u2010\n                      <jats:styled-content style=\"fixed-case\">WorldReg<\/jats:styled-content>\n                      's partner). Data were registered at e\u2010\n                      <jats:styled-content style=\"fixed-case\">CRF AEG<\/jats:styled-content>\n                      \u2010\n                      <jats:styled-content style=\"fixed-case\">ReCap<\/jats:styled-content>\n                      from March 2022 to October 2024 and analyzed via modified intention\u2010to\u2010treat (\n                      <jats:styled-content style=\"fixed-case\">mITT<\/jats:styled-content>\n                      ) methodology. Data were subject to quality review.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      572 patients (mean age 52\u2009years, 64% women) were included. The primary treatment indications were dyspepsia (64%) and gastroduodenal ulcer (9.2%). Among them, 67% underwent second\u2010line therapy, while 33% received third\u2010line or subsequent treatments. Proton\u2010pump inhibitors (\n                      <jats:styled-content style=\"fixed-case\">PPIs<\/jats:styled-content>\n                      ) were administered at low (40%), standard (10%), and high doses (24%), with vonoprazan used in 26% of cases. The overall eradication rate for second\u2010line treatment was 74%, with the most common regimen being triple therapy (\n                      <jats:styled-content style=\"fixed-case\">PPI<\/jats:styled-content>\n                      \u2009+\u2009amoxicillin\u2009+\u2009levofloxacin), achieving 73% eradication for 14\u2009days and 57% for 10\u2009days. Adding bismuth to the 14\u2010day regimen increased effectiveness to 100% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.016). In third\u2010line therapy, a regimen of\n                      <jats:styled-content style=\"fixed-case\">PPI<\/jats:styled-content>\n                      \u2010bismuth\u2010tetracycline\u2010metronidazole yielded an 87% cure rate. The fourth\u2010line dual therapy with amoxicillin\u2010vonoprazan achieved 100% eradication, while bismuth\u2010quadruple therapy showed similar results. Dual therapy with vonoprazan and amoxicillin was also effective in fifth\u2010line treatments, achieving 100% effectiveness. Mild adverse events occurred in 23% of patients, with nausea being the most common (14%), and compliance was 99%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In Brazil, the overall effectiveness of second\u2010line therapy was suboptimal (&lt;\u200990%); however, the combination of bismuth\u2010amoxicillin\u2010levofloxacin prescribed for 14\u2009days reported successful cure rates. In the third\u2010line, the classical bismuth\u2010quadruple therapy with metronidazole\u2010tetracycline provided acceptable results (87%). Alternatively, dual therapy with vonoprazan and amoxicillin and rifabutin\u2010based bismuth\u2010quadruple therapy showed promising results in third\u2010 and fifth\u2010line rescue treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hel.70077","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T04:21:32Z","timestamp":1760502092000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Empirical Rescue Eradication Therapy for\n                    <scp>\n                      <i>Helicobacter pylori<\/i>\n                    <\/scp>\n                    Infection in Second and Subsequent Treatment Lines: Experience From 500 Cases of the Brazilian Registry on\n                    <scp>\n                      <i>H. pylori<\/i>\n                    <\/scp>\n                    Management (Hp\u2010\n                    <scp>BrazilReg<\/scp>\n                    )"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0193-6292","authenticated-orcid":false,"given":"B. 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