title: Management of Helicobacter pylori infection in Latin America: a Delphi technique-based consensus.
abstract: OBJECTIVE
  To optimize diagnosis and treatment guidelines for this geographic region, a panel of gastroenterologists, epidemiologists, and basic scientists carried out a structured evaluation of available literature.
  
  
  METHODS
  Relevant questions were distributed among the experts, who generated draft statements for consideration by the entire panel. A modified three-round Delphi technique method was used to reach consensus. Critical input was also obtained from representatives of the concerned medical community. The quality of the evidence and level of recommendation supporting each statement was graded according to United States Preventive Services Task Force criteria.
  
  
  RESULTS
  A group of ten experts was established. The survey included 15 open-ended questions that were distributed among the experts, who assessed the articles associated with each question. The levels of agreement achieved by the panel were 50% in the first round, 73.3% in the second round and 100% in the third round. Main consensus recommendations included: (1) when available, urea breath and stool antigen test (HpSA) should be used for non-invasive diagnosis; (2) detect and eradicate Helicobacter pylori (H. pylori) in all gastroscopy patients to decrease risk of peptic ulcer disease, prevent o retard progression in patients with preneoplastic lesions, and to prevent recurrence in patients treated for gastric cancer; (3) further investigate implementation issues and health outcomes of H. pylori eradication for primary prevention of gastric cancer in high-risk populations; (4) prescribe standard 14-d triple therapy or sequential therapy for first-line treatment; (5) routinely assess eradication success post-treatment in clinical settings; and (6) select second- and third-line therapies according to antibiotic susceptibility testing.
  
  
  CONCLUSIONS
  These achievable steps toward better region-specific management can be expected to improve clinical health outcomes.
authors.affiliation: Antonio Rollan, Pablo Cortés, Luisa Durán, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7650568, Chile.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rollan
authors.affiliation: Antonio Rollan, Pablo Cortés, Luisa Durán, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7650568, Chile.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Arab
authors.affiliation: Antonio Rollan, Pablo Cortés, Luisa Durán, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7650568, Chile.
authors.forename: M Constanza
authors.initials: MC
authors.lastname: Camargo
authors.affiliation: Antonio Rollan, Pablo Cortés, Luisa Durán, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7650568, Chile.
authors.forename: Roberto
authors.initials: R
authors.lastname: Candia
authors.affiliation: Antonio Rollan, Pablo Cortés, Luisa Durán, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7650568, Chile.
authors.forename: Paul
authors.initials: P
authors.lastname: Harris
authors.affiliation: Antonio Rollan, Pablo Cortés, Luisa Durán, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7650568, Chile.
authors.forename: Catterina
authors.initials: C
authors.lastname: Ferreccio
authors.affiliation: Antonio Rollan, Pablo Cortés, Luisa Durán, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7650568, Chile.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Rabkin
authors.affiliation: Antonio Rollan, Pablo Cortés, Luisa Durán, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7650568, Chile.
authors.forename: Juan Cristóbal
authors.initials: JC
authors.lastname: Gana
authors.affiliation: Antonio Rollan, Pablo Cortés, Luisa Durán, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7650568, Chile.
authors.forename: Pablo
authors.initials: P
authors.lastname: Cortés
authors.affiliation: Antonio Rollan, Pablo Cortés, Luisa Durán, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7650568, Chile.
authors.forename: Rolando
authors.initials: R
authors.lastname: Herrero
authors.affiliation: Antonio Rollan, Pablo Cortés, Luisa Durán, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7650568, Chile.
authors.forename: Luisa
authors.initials: L
authors.lastname: Durán
authors.affiliation: Antonio Rollan, Pablo Cortés, Luisa Durán, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7650568, Chile.
authors.forename: Apolinaria
authors.initials: A
authors.lastname: García
authors.affiliation: Antonio Rollan, Pablo Cortés, Luisa Durán, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7650568, Chile.
authors.forename: Claudio
authors.initials: C
authors.lastname: Toledo
authors.affiliation: Antonio Rollan, Pablo Cortés, Luisa Durán, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7650568, Chile.
authors.forename: Alberto
authors.initials: A
authors.lastname: Espino
authors.affiliation: Antonio Rollan, Pablo Cortés, Luisa Durán, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7650568, Chile.
authors.forename: Nicole
authors.initials: N
authors.lastname: Lustig
authors.affiliation: Antonio Rollan, Pablo Cortés, Luisa Durán, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7650568, Chile.
authors.forename: Alberto
authors.initials: A
authors.lastname: Sarfatis
authors.affiliation: Antonio Rollan, Pablo Cortés, Luisa Durán, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7650568, Chile.
authors.forename: Catalina
authors.initials: C
authors.lastname: Figueroa
authors.affiliation: Antonio Rollan, Pablo Cortés, Luisa Durán, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7650568, Chile.
authors.forename: Javier
authors.initials: J
authors.lastname: Torres
authors.affiliation: Antonio Rollan, Pablo Cortés, Luisa Durán, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7650568, Chile.
authors.forename: Arnoldo
authors.initials: A
authors.lastname: Riquelme
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001431:Bacteriological Techniques; D032921:Consensus; D003697:Delphi Technique; D018450:Disease Progression; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D010437:Peptic Ulcer / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011230:Precancerous Conditions / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D011237:Predictive Value of Tests; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012008:Recurrence; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors
keywords: Consensus development conference; Delphi technique; Helicobacter pylori; Latin America