doi:10.14309/ajg.0000000000003351engDeza, Diego CasasAlcedo, JavierLafuente, MiguelLópez, F. JavierPerez-Aisa, ÁngelesPavoni, MatteoTepes, BojanJonaitis, LaimasCastro-Fernandez, ManuelPabón-Carrasco, ManuelKeco-Huerga, AlmaVoynovan, IrinaBujanda, LuisLucendo, Alfredo J.Jurecic, Natasa BrglezDenkovski, MajaVologzanina, LudmilaRodrigo, LuisMartínez-Domínguez, Samuel J.Fadieienko, GalynaHuguet, Jose M.Abdulkhakov, RustamAbdulkhakov, Sayar R.Alcaide, NoeliaVelayos, BenitoHernández, LuisBordin, Dmitry S.Gasbarrini, AntonioKupcinskas, JuozasBabayeva, GülüstanGridnyev, OleksiyLeja, MarcisRokkas, TheodoreMarcos-Pinto, RicardoLerang, FrodeBoltin, DoronMestrovic, AntonioSmith, Sinead M.Venerito, MarinoBoyanova, LyudmilaMilivojevic, VladimirDoulberis, MichaelKunovsky, LumirParra, PabloCano-Català, AnnaMoreira, LeticiaNyssen, Olga P.Megraud, FrancisMorain, Colm OGisbert, Javier P.Probiotics prescribed with Helicobacter Pylori eradication therapy in europe: usage pattern, effectiveness, and safety: results from the European Registry on Helicobacter Pylori Management (Hp-EuReg)ART-2025-143049Aim: To evaluate the prescriptions patterns, effectiveness, and safety of adding probiotics to Helicobacter pylori eradication therapy, in Europe. Design: International, prospective, non-interventional registry of the clinical practice of the European gastroenterologists. Data were collected and quality reviewed until March 2021 at AEG-REDCap. The effectiveness was evaluated by modified intention-to-treat analysis, differentiating by geographic areas. Adverse events (AE) were categorized as mild, moderate, and severe. Results: Overall, 36,699 treatments were recorded, where 8,233 (22%) were prescribed with probiotics. Probiotics use was associated with higher effectiveness in the overall analysis (OR 1.631 [95% CI 1.456-1.828]), as well as in triple (1.702 [1.403-2.065]), quadruple (1.383 [0.996-1.920]), bismuth quadruple (1.248 [1.003-1.554] and sequential therapies (3.690 [2.686-5.069]). Lactobacillus genus was associated with a higher therapy effectiveness in Eastern Europe when triple (OR: 2.625 [CI 1.911, 3.606]) and bismuth quadruple (OR: 1.587 [CI 1.117, 2.254]) first-line therapies were prescribed. In Central Europe, the use of probiotics was associated with a decrease in both the overall incidence of AEs (0.656 [0.516, 0.888]) as well as severe AEs (0.312; [0.217, 0.449]). Bifidobacterium genus was associated with lower overall (OR: 0.725 [95% CI 0.592-0.888]) and severe (OR: 0.254 [0.185-0.347]) AEs; and Saccharomyces was associated with reduced overall (OR: 0.54 [CI 0.32-0.91]) and severe (OR 0.257 [CI 0.123-0.536]) AEs under quadruple-bismuth regimen. Conclusions: In Europe, the use of probiotics was associated with higher effectiveness and safety of H. pylori eradication therapy. Lactobacillus improved treatment effectiveness, while Bifidobacterium and Saccharomyces were associated with a better safety profile.2025http://zaguan.unizar.es/record/16605010.14309/ajg.0000000000003351http://zaguan.unizar.es/record/166050oai:zaguan.unizar.es:166050American Journal of Gastroenterology 120, 11 (2025), 2644-2659by-nc-ndhttps://creativecommons.org/licenses/by-nc-nd/4.0/deed.esinfo:eu-repo/semantics/embargoedAccess