Second Asia-Pacific Consensus Guidelines for Helicobacter pylori infection.
The Asia-Pacific Consensus Conference was convened to review and synthesize the most current information on Helicobacter pylori management so as to update the previously published regional guidelines. The group recognized that in addition to long-established indications, such as peptic ulcer disease, early mucosa-associated lymphoid tissue (MALT) type lymphoma and family history of gastric cancer, H. pylori eradication was also indicated for H. pylori infected patients with functional dyspepsia, in those receiving long-term maintenance proton pump inhibitor (PPI) for gastroesophageal reflux disease, and in cases of unexplained iron deficiency anemia or idiopathic thrombocytopenic purpura. In addition, a population 'test and treat' strategy for H. pylori infection in communities with high incidence of gastric cancer was considered to be an effective strategy for gastric cancer prevention. It was recommended that H. pylori infection should be tested for and eradicated prior to long-term aspirin or non-steroidal anti-inflammatory drug therapy in patients at high risk for ulcers and ulcer-related complications. In Asia, the currently recommended first-line therapy for H. pylori infection is PPI-based triple therapy with amoxicillin/metronidazole and clarithromycin for 7 days, while bismuth-based quadruple therapy is an effective alternative. There appears to be an increasing rate of resistance to clarithromycin and metronidazole in parts of Asia, leading to reduced efficacy of PPI-based triple therapy. There are insufficient data to recommend sequential therapy as an alternative first-line therapy in Asia. Salvage therapies that can be used include: (i) standard triple therapy that has not been previously used; (ii) bismuth-based quadruple therapy; (iii) levofloxacin-based triple therapy; and (iv) rifabutin-based triple therapy. Both CYP2C19 genetic polymorphisms and cigarette smoking can influence future H. pylori eradication rates.
Division of Gastroenterology, Department of Medicine, Changi General Hospital, Singapore 529889. kwong_ming_fock@cgh.com.sg
K Ming
KM
Fock
Peter
P
Katelaris
Kentaro
K
Sugano
Tiing Leong
TL
Ang
Richard
R
Hunt
Nicholas J
NJ
Talley
Shiu Kum
SK
Lam
Shu-Dong
SD
Xiao
Huck Joo
HJ
Tan
Chun-Ying
CY
Wu
Hyun Chae
HC
Jung
Bui Huu
BH
Hoang
Udom
U
Kachintorn
Khean-Lee
KL
Goh
Tsutomu
T
Chiba
Abdul Aziz
AA
Rani
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001208:Asia / Q000453:epidemiology; D044466:Asian People; D001944:Breath Tests; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis / Q000208:ethnology / Q000382:microbiology / Q000628:therapy*; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008828:Microbiological Techniques; D011237:Predictive Value of Tests; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors