Cut off the "carcinogenic" Helicobacter pylori family prevention and control China consensus published GUT from the source

Helicobacter pylori (H.

It is particularly important to eradicate Helicobacter pylori to reduce the occurrence of related diseases

At present, all patients with Helicobacter pylori infection are known to have histological gastritis;

Some infected people have no symptoms or signs, and 25%~30% of Helicobacter pylori infections will have gastrointestinal diseases of varying degrees, such as dyspepsia, chronic gastritis, peptic ulcer, gastric malignant tumors, etc.

Helicobacter pylori infection is also related to a variety of extra-gastrointestinal diseases, such as iron deficiency anemia, idiopathic thrombocytopenic purpura, autoimmune diseases, cardiovascular diseases, and cerebrovascular diseases

In particular, Helicobacter pylori infection is one of the most clear gastric cancer risk factors

Recently, the "Consensus Report on the Prevention, Control and Management of Helicobacter Pylori Infection in Chinese Households (2021 Edition)" (hereinafter referred to as the "Consensus") was published in the well-known medical journal GUT in the gastrointestinal field, providing ordinary residents with prevention and control related to daily family life.

Screenshot source: GUT

The consensus formed 16 statements, covering three aspects: (1) Helicobacter pylori infection and transmission among family members, (2) Prevention and management of Helicobacter pylori infection in children and the elderly in the family, (3) Helicobacter pylori family members Prevention and management strategies for bacterial infections

This time it was published in an international journal, the consensus also pointed out that the prevention and control experience of Helicobacter pylori is not only beneficial to China, but also of reference value to other regions of the world with high infection rates and high burden of related diseases

Why is prevention and control within the family so important?

The consensus points out that Helicobacter pylori infection is to a large extent a familial disease

Traditional prevention and control strategies include "test-treatment" and "screening-treatment" strategies

"Test-treatment": for uninvestigated patients <60 years of age with dyspeptic symptoms, cost-effective in areas with low infection rates

"Screening-treatment": Suitable for patients in areas with high infection rates, or with family history of gastric cancer, alarm symptoms, and living in areas where gastric cancer is endemic

However, it has also been found in daily clinical practice that in China, the low-endemic area of ​​Helicobacter pylori is difficult to distinguish from the high-infection communities; the treatment process is also affected by patient compliance and the choice of treatment population; and if the infected family members are not involved , It is difficult to control the infection from the source

Therefore, the introduction of family-based management and control concepts and corresponding prevention and control strategies not only solve the problems of patients in the hospital, but also pay attention to the subsequent reinfection and infection of other family members, as well as the progress of gastric mucosal lesions, and other related issues, which will help prevent Stop the spread of Helicobacter pylori within the family, promote the eradication of Helicobacter pylori, and prevent re-infection after eradication

Consensus: the spread of Helicobacter pylori in the family

Consensus 1.

Intra-family transmission is an important way of Helicobacter pylori infection

A large number of studies in China and around the world have shown that Helicobacter pylori infection has obvious family clustering phenomenon:

When parents have Helicobacter pylori infection, their children's Helicobacter pylori infection rate increases significantly;

There are also transmission phenomena between spouses and between compatriots

Consensus 2.
Helicobacter pylori is mainly transmitted through oral route in the family
.

Oral-to-mouth transmission:

Transmission: sharing the same eating utensils, chew food feeding; eating contaminated meat, milk, vegetables and other food, drinking contaminated water; and poor health habits
.

Preventive measures: It is recommended to share meals, use public chopsticks, public spoons, etc.
, eat healthy and safe food, and avoid chewing and feeding infants and young children
.

Spread from shared equipment:

Transmission: common food containers or dental equipment
.

Preventive measures: Clean food containers and use safe dental equipment
.

Fecal-oral route of transmission:

Transmission route: eating food contaminated by excrement, drinking contaminated water, and untreated water such as well water
.

Preventive measures: Only eat hygienic and safe food and water
.

Consensus 3.
Family members infected with Helicobacter pylori are always potential sources of infection and have the possibility of continuing to spread to other family members
.

People with Helicobacter pylori infection rarely recover without treatment.
When living with family members who are infected with Helicobacter pylori, other members are at increased risk of infection, but whether the infection is related to the intimacy of contact and genetic background
.

Consensus 4.
Most Helicobacter pylori infections occur in children and adolescents, and they can also be infected in adulthood
.

Intra-family transmission is the main way for children to be infected with Helicobacter pylori, and it is mainly transmitted by parents, especially mothers
.
The results of surveys in many places in China suggest that the infection rate of Helicobacter pylori among children increases with age
.

Consensus 5.
For all adults with Helicobacter pylori infection in the family, eradication treatment should be considered
.

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The Helicobacter pylori infection rate in the elderly is relatively high, and eradication treatment can improve the gastrointestinal symptoms of elderly patients, and to some extent prevent or delay or even partially reverse the occurrence of gastric mucosal atrophy and intestinal metaplasia
.
However, elderly patients with Helicobacter pylori infection often suffer from multiple other systemic diseases at the same time and complicated medications.
Therefore, before eradication treatment, the risks and benefits should be assessed and individualized and standardized treatment options should be selected
.

Consensus: Use the family as a unit to prevent and control Helicobacter pylori infection

Consensus 9.
"Family-based prevention and control of Helicobacter pylori infection" is an important strategy to block Helicobacter pylori infection and transmission
.

Helicobacter pylori is mainly transmitted by oral route.
Strengthening education and prevention and control of cross-infection among family members living together can reduce the incidence of infection from the source
.

Consensus 10.
Co-treatment of family members with Helicobacter pylori infection can help reduce reinfection after eradication
.

The results of the study suggest that the reinfection and recurrence rate after eradication of Helicobacter pylori is 0%~10%, which varies in different regions
.

Similar living habits, sharing of living utensils, close contact and other reasons may lead to the spread of Helicobacter pylori among family members, which is also one of the reasons why some patients fail to treat Helicobacter pylori
.
Small-scale studies have shown that family co-treatment can effectively cut off the transmission of Helicobacter pylori among members, reduce the recurrence rate and increase the cure rate
.

Consensus 11.
For patients with gastric cancer or gastric mucosal precancerous lesions, family members living together should be screened for Helicobacter pylori
.

Family members of patients with gastric cancer are at high risk of gastric cancer and should be tested for Helicobacter pylori, and those who are positive should be treated for eradication; for patients with gastric mucosal precancerous lesions such as atrophic gastritis and intestinal metaplasia, Helicobacter pylori should also be clear Infection, and regular endoscopy
.

Although other factors such as genetics, physical and chemical factors, diet, life>
.

Consensus 12.
The bismuth quadruple regimen is the first choice for the treatment of Helicobacter pylori eradication in family members
.

A bismuth-containing quadruple regimen (PPI+bismuth+2 antibiotics) is recommended as the main empirical treatment plan
.
The current eradication rate of this program exceeds 85%, and in some cases exceeds 90%
.

New options that have been preliminarily verified in recent years include: high-dose, high-frequency PPI+amoxicillin dual therapy, with an eradication rate similar to quadruple therapy; and a potassium ion pump blocker (P-CAB)-based program
.

Consensus 13.
The concept of “first treatment is eradication” applies to the treatment of Helicobacter pylori infection in family members
.

In recent years, with the widespread development of eradication therapy, the resistance rate of Helicobacter pylori to antibiotics has gradually increased
.
Failure to eradicate for the first time can easily lead to the emergence of bacterial resistance, which narrows the range of medication options for retreatment
.

Consensus 14.
The Helicobacter pylori detection methods suitable for family members include urea breath test, serum antibody test and stool antigen test
.

The above tests are all non-invasive methods, currently commonly used in clinical practice and recommended by many consensuses at home and abroad
.
Actually, it needs to be selected according to its characteristics and advantages
.
Multiple methods are used in combination to help effective detection
.

Urea breath test: relatively high accuracy and specificity, easy to operate, not affected by the patchy distribution of Helicobacter pylori in the stomach
.
But when the detection value is close to the critical value, the result needs to be carefully judged
.
In addition, the results are easily affected by the use of clinical drugs.
Residual food in the stomach, partial gastrectomy, gastric bleeding, gastric tumors, severe atrophy of the gastric mucosa, or low gastric mucosal bacteria can also interfere with the test results
.

Serum antibody and stool antigen detection: Not affected by the above factors, but for patients after eradication treatment, due to the long-term existence of serum antibodies, the current infection cannot be confirmed and used for follow-up
.

Consensus 15.
Measures to prevent Helicobacter pylori infection from the public and community levels should include comprehensive family-based prevention and control
.

Consensus 16.
There is currently no effective vaccine to prevent Helicobacter pylori infection
.
Both prevention of new infections and eradication of existing infections are relatively effective infection prevention and control strategies
.

summary

The consensus finally pointed out that the new strategy of “family-based prevention and control of Helicobacter pylori infection” has changed the current clinical practice, from only treating people with Helicobacter pylori infection to actively managing the infection and disease status of the entire family, which is not only helpful To eliminate the source of infection in the family, it can also reduce the precancerous lesions of the gastric mucosa of family members.
At the same time, it is expected to promote the improvement of family hygiene habits and prevent other infectious diseases
.

Reference

[1] Ding S, Du Y, Lu H, et al.
, (2021).
Chinese Consensus Report on Family-Based Helicobacter pylori Infection Control and Management (2021 Edition).
Gut, doi: 10.
1136/gutjnl-2021-325630

[2] National Research Center for Clinical Medicine of Gastrointestinal Diseases (Shanghai), National Alliance of Gastrointestinal Early Cancer Prevention and Treatment Centers, Group of Helicobacter pylori and Peptic Ulcer of Digestive Diseases Branch of Chinese Medical Association, etc.
Helicobacter pylori infection in Chinese households Expert consensus on prevention, control and management of China (2021)[J].
Chinese Journal of Digestion.
2021,41(4): 221-233.
DOI: 10.
3760/cma.
j.
cn311367-20210219-00108.