Mototsugu Kato1, Hiroyoshi Ota2, Masumi Okuda3, Shogo Kikuchi4, Kiichi Satoh5, Tadashi Shimoyama6, Hidekazu Suzuki7, Osamu Handa8, Takahisa Furuta9, Katsuhiro Mabe1, Kazunari Murakami10, Toshiro Sugiyama11, Naomi Uemura12, Shin'ichi Takahashi13. 1. Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Hokkaido, Japan. 2. Department of Clinical Laboratory Sciences, Shinshu University School of Medicine, Nagano, Hyogo, Japan. 3. Department of Pediatrics, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan. 4. Department of Public Health, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan. 5. Department of Gastroenterology, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan. 6. Aomori General Health Examination Center, Aomori, Japan. 7. Fellowship Training Center, Medical Education Center, Keio University School of Medicine, Tokyo, Japan. 8. Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan. 9. Center for Clinical Research, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan. 10. Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan. 11. Department of Cancer Prevention and Therapeutics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan. 12. Department of Gastroenterology, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Japan. 13. Department of Gastroenterology, Kosei Hospital, Tokyo, Japan.
Abstract
BACKGROUND: Since "Helicobacter pylori (H. pylori) infection" was set as the indication in the Japanese Society for Helicobacter Research (JSHR) Guidelines 2009, eradication treatment for H. pylori gastritis is covered under insurance since 2013 in Japan, and the number of H. pylori eradication has rapidly increased. Under such circumstances, JSHR has made the third revision to the "Guidelines for diagnosis and treatment of H. pylori infection" for the first time in 7 years. METHODS: The Guideline Committee held 10 meetings. Articles published between the establishment of the 2009 Guidelines and March 2016 were reviewed and classified according to the evidence level; the statements were revised on the basis of this review. After inviting public comments, the revised statements were finalized using the Delphi method. RESULTS: There was no change in the basic policy that H. pylori infectious disease is an indication for eradication. Other diseases presumed to be associated with H. pylori infection were added as indications. Serum pepsinogen level, endoscopic examination, and X-ray examination were added to the diagnostic methods. The effects of 1-week triple therapy consisting of potassium-competitive acid blocker (P-CAB), amoxicillin, and clarithromycin have improved, and high eradication rates can also be expected with proton pump inhibitors (PPI) or P-CAB combined with amoxicillin and metronidazole. If the susceptibility test is not performed, the triple PPI or P-CAB/amoxicillin/metronidazole therapy should be chosen, because the PPI/amoxicillin/metronidazole combination demonstrated a significantly higher eradication rate than PPI/amoxicillin/clarithromycin. In the proposal for gastric cancer prevention, we divided gastric cancer prevention measures by age from adolescent to elderly, who are at an increased gastric cancer risk, and presented measures for gastric cancer prevention primarily based on H. pylori eradication. CONCLUSION: We expect the revised guidelines to facilitate appropriate interventions for patients with H. pylori infection and accomplish its eradication and prevention of gastric cancer.
BACKGROUND: Since "Helicobacter pylori (H. pylori) infection" was set as the indication in the Japanese Society for Helicobacter Research (JSHR) Guidelines 2009, eradication treatment for H. pylorigastritis is covered under insurance since 2013 in Japan, and the number of H. pylori eradication has rapidly increased. Under such circumstances, JSHR has made the third revision to the "Guidelines for diagnosis and treatment of H. pyloriinfection" for the first time in 7 years. METHODS: The Guideline Committee held 10 meetings. Articles published between the establishment of the 2009 Guidelines and March 2016 were reviewed and classified according to the evidence level; the statements were revised on the basis of this review. After inviting public comments, the revised statements were finalized using the Delphi method. RESULTS: There was no change in the basic policy that H. pyloriinfectious disease is an indication for eradication. Other diseases presumed to be associated with H. pyloriinfection were added as indications. Serum pepsinogen level, endoscopic examination, and X-ray examination were added to the diagnostic methods. The effects of 1-week triple therapy consisting of potassium-competitive acid blocker (P-CAB), amoxicillin, and clarithromycin have improved, and high eradication rates can also be expected with proton pump inhibitors (PPI) or P-CAB combined with amoxicillin and metronidazole. If the susceptibility test is not performed, the triple PPI or P-CAB/amoxicillin/metronidazole therapy should be chosen, because the PPI/amoxicillin/metronidazole combination demonstrated a significantly higher eradication rate than PPI/amoxicillin/clarithromycin. In the proposal for gastric cancer prevention, we divided gastric cancer prevention measures by age from adolescent to elderly, who are at an increased gastric cancer risk, and presented measures for gastric cancer prevention primarily based on H. pylori eradication. CONCLUSION: We expect the revised guidelines to facilitate appropriate interventions for patients with H. pyloriinfection and accomplish its eradication and prevention of gastric cancer.
Authors: Shailja C Shah; Adam Tepler; Cecilia P Chung; Giovanni Suarez; Richard M Peek; Adriana Hung; Christianne Roumie; Neeraj Narula Journal: Gastroenterology Date: 2021-08-03 Impact factor: 22.682