AGA guidelines update: With minimal attempt to eradicate the incurable Helicobacterium infection

Helicobacter bacillus (H. Pylori, HP), formerly known as Helicobacter pylori, is a Gram-negative micro-oxygen-demanding bacteria that usually grows in the stomach.
Australian scientists Barry Marshall and Robin Warren discovered the bacteria in 1982 and won the Nobel Prize for it.
their study showed for the first time that HP infections were common in people with chronic gastritis and stomach ulcers, which had not previously been thought to be caused by microbes.
, the infection rate of helicobacter pyridobacteria (HP) in the natural population exceeds 50%, CCTV reported on November 12.
the probability of HP infection varies significantly from region to region in China, with an average infection rate of 59%, of which the average infection rate of children is 40%.
hp infection rate is a global burden of disease.
In the case of stomach cancer alone, a worldwide modelling study of the burden of noncommunicable diseases caused by infectious diseases, published last October in Lancet, showed that the global burden of stomach cancer caused by HP in 2017 was as high as 14.6 million disability-adjusted life years.
, HP is classified as a Class 1 carcinogen by the World Health Organization's International Agency for Research on Cancer (IARC), the most important and controllable risk factor for stomach cancer.
prevention and treatment of HP is also imperative.
, however, due to declining eradication rates and increased antibiotic resistance, the difficulty of clinical first-line therapy in eradicating infections has become an increasingly serious treatment challenge.
, the American Gastroenterology Association (AGA) recently updated clinical guidelines for the treatment of incurable HP infections in the journal Gastroenterology.
updated guidelines, the group again stressed that HP infection is an important public health event that not only increases the cost of treating complications and medical care, but also significantly increases the risk of peptic ulcers and even stomach cancer.
the increase in the number of treatments reduces the chances of successful eradication, the Expert Group recommends that attempts be made to increase the success rate of HP eradication with a minimum number of treatments.
The specific clinical recommendations are as follows: 1) the factors that lead to the failure of the treatment should be determined as far as possible, such as antibiotic resistance, poor treatment compliance and insufficient acid suppression of the stomach;
3) A comprehensive understanding of the patient's previous use of antibiotics to reduce the risk of drug resistance.
For example, patients who use large cyclocycline or quinone drugs should avoid LOX or kramycin as the basis for treatment, and use tetrycline or amoxicillin as an alternative treatment.
4) It is recommended to use proton pump inhibitors (PPI) that are efficient and not metabolized by the liver CYP2C19, or to try newer potassium ion competitive acid inhibitors (P-CAB).
5) Choosing a longer treatment time option as much as possible has reduced the likely failure of treatment.
6) When considering the use of methazole, a sufficient amount of methazole (1.5-2g/d) should be given under the premise of the use of methazole to improve the success rate of treatment.
7) In patients treated with amoxilin, the daily dose should be at least 2 g to maintain blood levels.
8) After the patient has maintained good compliance but failed both treatments, consider conducting a drug sensitivity test to guide the choice of follow-up treatment options.
9) The benefits of complementary therapies (including probiotics) have not been proven and should be considered experimental only.
" drug-resistant HP for amoxilin is not common, usually less than 5%, so amoxirin is of great value in treating refrac treatment of refrac treatment of HP.
, the importance of adequate and sustained suppression of stomach acid for the successful eradication of HP may not have been fully understood," said Shailja C. Shah of Vanderbilt University, co-author of the study.
, Dr. Hashem B. El-Serag of Baylor Medical School, who was not involved in the guidelines, agrees and believes that antibiotic sensitivity testing after a round of treatment failures may improve success rates.
: Shah SC, et al. AGA Clinical Practice Update on The Management of Refractory Helicobacter pylori Infection: Expert Review. Gastroenterology. 2021 Jan 29:S0016-5085 (21)00319-X. doi: 10.1053/j.gastro.2020.11.059.MedSci Original Source: MedSci Original Copyright Notice: All text, images and audio and video materials on this website that indicate "Source: Met Medical" or "Source: MedSci Original" are owned by Mets Medicine and are not reproduced by any media, website or individual without authorization, and are authorized to be reproduced with the words "Source: Mets Medicine".
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