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It is only for medical professionals to read for reference.
It may not be useful to treat the whole family at the same time.
.
.
Helicobacter pylori (Hp) infection is a thorny public health problem worldwide, and long-term chronic infections are inseparable from the incidence of gastric cancer
.
In order to reduce the heavy medical burden caused by Hp-related diseases, China has successively launched multiple versions of Hp prevention and treatment consensus.
Many outstanding experts and scholars have also achieved outstanding results on the research topic of "resolving the decline of Hp eradication effect caused by antibiotic resistance"
.
However, in addition to the high rate of Hp infection (50%, about half of the residents in China), the secondary infection after Hp treatment is another major challenge that urgently needs to be faced.
It is understood that the global Hp eradication recurrence rate is within the past 10 years.
Shows an upward trend [1]
.
However, due to the unique eating habits in China (no meal sharing system, seldom use of serving chopsticks, etc.
), the risk of oral-to-oral transmission of Hp during family dinners is higher
.
Therefore, according to China’s national conditions, more than 50 top experts in China have worked together to release the "Expert Consensus on the Prevention, Control and Management of Helicobacter Pylori Infection in Chinese Households (2021)" between April and April this year, and the The concept of "family as a unit to prevent and control Hp"[2]
.
What are the exciting contents of the consensus? Let's take a look! Hp's efficient prevention and control method: prevention and control with the family as a unit! 1 Infection and transmission of Hp in households [Statement 1] Hp is a pathogen that can be transmitted between family members
.
Interpersonal transmission is an important way of Hp transmission
.
A large number of domestic and foreign studies and meta-analysis results have shown that there is an obvious family gathering phenomenon in Hp infection
.
The results of the investigation of the family status of patients with Hp infection found that when the parents have Hp infection, the Hp infection rate of their children is significantly increased; there are also transmission phenomena between spouses and siblings
.
These results suggest that intra-family transmission is an important way of Hp infection
.
[Statement 2] Hp is mainly transmitted by oral route, and transmission within the family is one of the main ways of its infection
.
[Statement 3] Family members infected by Hp are always potential sources of infection, with the possibility of continued transmission
.
[Statement 4] Most Hp infections occur in children and adolescents, and can also be infected in adulthood
.
A number of studies have shown that intra-family transmission is the main route for children to contract Hp, and it is mainly transmitted by parents, especially mothers
.
Common ways of infection among family members include sharing utensils, sharing food, chewing and feeding, kissing, and poor hygiene habits
.
[Statement 5] For all adult Hp infections in the family, eradication treatment should be considered
.
[Statement 6] The relationship between Hp infection and gastric mucosal lesions in children in the family needs further research
.
2 Prevention, control and management of Hp infection in children and the elderly in the family [Statement 7] Children Hp infection in the family should be managed based on risk-benefit assessment and related disease status
.
The Gastroenterology Group of the Pediatrics Branch of the Chinese Medical Association formulated the Expert Consensus on the Diagnosis and Treatment of Helicobacter Pylori Infection in Children in 2015
.
The consensus recommendation: Hp eradication treatment is required for children with Hp infection with peptic ulcer and gastric MALT lymphoma; for chronic gastritis, family history of gastric cancer, unexplained refractory iron deficiency anemia, plan to take NSAID for a long time ( Children with Hp infection, including low-dose aspirin, guardians or older children (aged 12 to 14 years) who strongly demand treatment, can be given eradication therapy
.
Indications for detection of children with Hp infection include the above conditions and children with gastric cancer among first-degree relatives, but Hp infection detection is not recommended as a routine test item
.
[Statement 8] For elderly Hp infections in the family, Hp infection treatment strategies should be formulated according to individual conditions
.
The elderly population has a higher Hp infection rate.
Eradication of Hp can improve the gastrointestinal symptoms of elderly patients, and to some extent prevent or delay the occurrence of gastric mucosal atrophy and intestinal metaplasia, and even part of the gastric mucosal atrophy Or intestinal metaplasia is reversed
.
Studies in China have shown that the resistance rate of the elderly to antibiotics commonly used to eradicate Hp has not increased significantly.
If there are no counter-factors, eradication treatment can be given
.
However, elderly people with Hp infection often suffer from cardiovascular, cerebrovascular, kidney and other system diseases at the same time, or take NSAIDs for a long time
.
Therefore, before carrying out Hp eradication treatment, risk and benefit assessment should be carried out, and individualized and standardized treatment plans should be selected according to the patient's previous drug intake, physiological characteristics, disease and drug adverse reactions
.
3 Prevention, control and management of Hp infection in families [Statement 9] "Prevention and control of Hp infection with the family as a unit" is an important strategy to block Hp infection and transmission
.
[Statement 10] Co-treatment of Hp-infected family members can help reduce re-infection after eradication
.
Family members living together may cause the transmission of Hp among family members due to similar living habits, sharing living appliances, close contact, etc.
This is also one of the reasons for the failure of Hp treatment in some patients
.
Small-scale studies at home and abroad have shown that family co-treatment of Hp infection can effectively cut off the transmission of Hp among members, reduce the recurrence rate and increase the cure rate
.
[Statement 11] For patients with gastric cancer or gastric mucosal precancerous lesions, family members living with them should be screened for Hp
.
Hp infection has typical family clustering characteristics, and Hp infection among first-degree relatives of gastric cancer patients usually has a higher risk of gastric mucosal lesions
.
[Statement 12] The treatment plan proposed in China's "Fifth National Consensus Report on the Treatment of Helicobacter Pylori Infection" is suitable for the eradication of H.
pylori in family members
.
(1) PPI + bismuth + 2 antibiotics China's "Fifth National Consensus Report on the Treatment of Helicobacter Pylori Infection" recommended a bismuth-containing quadruple plan (PPI + bismuth + 2 antibiotics) as the main empirical eradication of Hp The treatment plan (recommended 7 plans, Table 3), the treatment course is 10 or 14 days, these plans are currently widely used in clinical practice
.
Table 1 Recommended quadruple eradication program in China's "Fifth National Consensus Report on the Treatment of Helicobacter Pylori Infection" Note: PPI is a proton pump inhibitor
.
a refers to any of esomeprazole 20 mg, rabeprazole 10 or 20 mg, omeprazole 20 mg, lansoprazole 30 mg, pantoprazole 40 mg, and ilaprazole 5 mg Choose one
.
The resistance rates of metronidazole, clarithromycin, and levofloxacin were relatively high, while the resistance rates of amoxicillin, furazolidone and tetracycline were relatively low
.
Family members can choose the quadruple regimen with good curative effect and low adverse drug reaction rate
.
Because bismuth does not have drug resistance, short-term application safety is high, unless bismuth is contraindicated, the empirical treatment plan for eradication of Hp in China recommends the use of bismuth quadruple regimen as much as possible
.
(2) PPI+Amoxicillin Dual Therapy Recently, high-dose, high-frequency PPI+Amoxicillin dual therapy has also been initially reported.
This method is simple, easy to implement, and has good patient compliance.
Its Hp eradication rate is similar to quadruple therapy.
, But this program is not suitable for patients who are allergic to amoxicillin, and the past history of amoxicillin use may lead to potential drug resistance risks.
If possible, it can be selected based on the results of drug susceptibility tests.
Its efficacy in large-scale populations It remains to be further verified
.
(3) The new potassium ion pump blocker At the same time, the new potassium ion pump blocker has a strong inhibitory effect on gastric acid secretion, lasts for a long time, and is not affected by cytochrome P450 (CYP) 2C19 gene polymorphism The influence of serotonin provides a new option for improving the eradication rate of Hp
.
[Statement 13] The concept that Hp is eradicated for the first time is applicable to the treatment of Hp infection in family members
.
Choosing high-efficiency acid-suppressing PPI to increase the pH value in the stomach and increase the bioavailability of antibiotics can increase the eradication rate of H.
pylori
.
In recent years, with the widespread development of Hp eradication therapy in China, the resistance rate of Hp to antibiotics has gradually increased, and the eradication rate of empirical therapy has shown a downward trend
.
Failure of the first eradication can easily lead to the emergence of bacterial drug resistance, which will narrow the range of medication options for retreatment.
Therefore, it should be successfully eradicated as soon as possible at the first treatment
.
[Statement 14] The urea breath test, serum antibody test and stool antigen test are applicable to the Hp test of family members
.
[Statement 15] Measures to prevent Hp infection from the public and community levels should include comprehensive prevention and control with the family as a unit
.
[Statement 16] In the absence of an effective vaccine, prevention of newborn Hp infection and eradication of existing infections in family members are both relatively effective infection prevention and control strategies
.
Wonderful preview of the next issue of the guide ~ As many readers and friends expressed their interest in Hp related content, the editor hereby successfully invited the author of this consensus, Professor Ding Songze, chief physician of the Department of Gastroenterology, Zhengzhou University People's Hospital, to interpret the consensus
.
More exciting, please lock in the digestive liver disease channel of the medical community~ see you in the next issue! References: [1] Zhao H, Yan P, Zhang N, et al.
Helicobacter 2021 Sep 12.
The recurrence rate of Helicobacter pylori in recent 10 years: A systematic review and meta-analysis.
10.
1111/hel.
12852.
[2 ] National Center for Clinical Medicine of Digestive Diseases (Shanghai), National Alliance of Centers for Prevention and Treatment of Early Gastrointestinal Cancer, Helicobacter pylori and Peptic Ulcer Group of Chinese Society of Gastroenterology, etc.
Prevention of Helicobacter pylori infection in Chinese households Expert consensus on control and management (2021)[J].
Chinese Journal of Digestion,2021,41(4):221-233.
DOI:10.
3760/cma.
j.
cn311367-20210219-00108.
Source of this article: Medical Digestive Liver Disease Channel Author of this article: Yan Ni, review of this article: Yang Health, Deputy Chief Physician of Jingdezhen Second People’s Hospital Editor: XU Copyright Statement If the original text of this article needs to be reproduced, please contact for authorization-End-The medical community strives to be accurate and reliable when the content is reviewed and approved.
However, it does not make any promises or guarantees on the timeliness of the published content, as well as the accuracy and completeness of the cited information (if any), and does not assume that the content is out of date, and the cited information may be inaccurate or inaccurate.
Any liability arising from completeness and other circumstances
.
Relevant parties are requested to check separately when adopting or using this as a basis for decision-making
.
Contributions are welcome to submit to the editor’s mailbox: xh@yxj.
org.
cn.
Please specify: [Submission] Hospital + department + name Contributions are in the form of word documents, others will not be considered.
Editor’s WeChat: xupeiyu96
It may not be useful to treat the whole family at the same time.
.
.
Helicobacter pylori (Hp) infection is a thorny public health problem worldwide, and long-term chronic infections are inseparable from the incidence of gastric cancer
.
In order to reduce the heavy medical burden caused by Hp-related diseases, China has successively launched multiple versions of Hp prevention and treatment consensus.
Many outstanding experts and scholars have also achieved outstanding results on the research topic of "resolving the decline of Hp eradication effect caused by antibiotic resistance"
.
However, in addition to the high rate of Hp infection (50%, about half of the residents in China), the secondary infection after Hp treatment is another major challenge that urgently needs to be faced.
It is understood that the global Hp eradication recurrence rate is within the past 10 years.
Shows an upward trend [1]
.
However, due to the unique eating habits in China (no meal sharing system, seldom use of serving chopsticks, etc.
), the risk of oral-to-oral transmission of Hp during family dinners is higher
.
Therefore, according to China’s national conditions, more than 50 top experts in China have worked together to release the "Expert Consensus on the Prevention, Control and Management of Helicobacter Pylori Infection in Chinese Households (2021)" between April and April this year, and the The concept of "family as a unit to prevent and control Hp"[2]
.
What are the exciting contents of the consensus? Let's take a look! Hp's efficient prevention and control method: prevention and control with the family as a unit! 1 Infection and transmission of Hp in households [Statement 1] Hp is a pathogen that can be transmitted between family members
.
Interpersonal transmission is an important way of Hp transmission
.
A large number of domestic and foreign studies and meta-analysis results have shown that there is an obvious family gathering phenomenon in Hp infection
.
The results of the investigation of the family status of patients with Hp infection found that when the parents have Hp infection, the Hp infection rate of their children is significantly increased; there are also transmission phenomena between spouses and siblings
.
These results suggest that intra-family transmission is an important way of Hp infection
.
[Statement 2] Hp is mainly transmitted by oral route, and transmission within the family is one of the main ways of its infection
.
[Statement 3] Family members infected by Hp are always potential sources of infection, with the possibility of continued transmission
.
[Statement 4] Most Hp infections occur in children and adolescents, and can also be infected in adulthood
.
A number of studies have shown that intra-family transmission is the main route for children to contract Hp, and it is mainly transmitted by parents, especially mothers
.
Common ways of infection among family members include sharing utensils, sharing food, chewing and feeding, kissing, and poor hygiene habits
.
[Statement 5] For all adult Hp infections in the family, eradication treatment should be considered
.
[Statement 6] The relationship between Hp infection and gastric mucosal lesions in children in the family needs further research
.
2 Prevention, control and management of Hp infection in children and the elderly in the family [Statement 7] Children Hp infection in the family should be managed based on risk-benefit assessment and related disease status
.
The Gastroenterology Group of the Pediatrics Branch of the Chinese Medical Association formulated the Expert Consensus on the Diagnosis and Treatment of Helicobacter Pylori Infection in Children in 2015
.
The consensus recommendation: Hp eradication treatment is required for children with Hp infection with peptic ulcer and gastric MALT lymphoma; for chronic gastritis, family history of gastric cancer, unexplained refractory iron deficiency anemia, plan to take NSAID for a long time ( Children with Hp infection, including low-dose aspirin, guardians or older children (aged 12 to 14 years) who strongly demand treatment, can be given eradication therapy
.
Indications for detection of children with Hp infection include the above conditions and children with gastric cancer among first-degree relatives, but Hp infection detection is not recommended as a routine test item
.
[Statement 8] For elderly Hp infections in the family, Hp infection treatment strategies should be formulated according to individual conditions
.
The elderly population has a higher Hp infection rate.
Eradication of Hp can improve the gastrointestinal symptoms of elderly patients, and to some extent prevent or delay the occurrence of gastric mucosal atrophy and intestinal metaplasia, and even part of the gastric mucosal atrophy Or intestinal metaplasia is reversed
.
Studies in China have shown that the resistance rate of the elderly to antibiotics commonly used to eradicate Hp has not increased significantly.
If there are no counter-factors, eradication treatment can be given
.
However, elderly people with Hp infection often suffer from cardiovascular, cerebrovascular, kidney and other system diseases at the same time, or take NSAIDs for a long time
.
Therefore, before carrying out Hp eradication treatment, risk and benefit assessment should be carried out, and individualized and standardized treatment plans should be selected according to the patient's previous drug intake, physiological characteristics, disease and drug adverse reactions
.
3 Prevention, control and management of Hp infection in families [Statement 9] "Prevention and control of Hp infection with the family as a unit" is an important strategy to block Hp infection and transmission
.
[Statement 10] Co-treatment of Hp-infected family members can help reduce re-infection after eradication
.
Family members living together may cause the transmission of Hp among family members due to similar living habits, sharing living appliances, close contact, etc.
This is also one of the reasons for the failure of Hp treatment in some patients
.
Small-scale studies at home and abroad have shown that family co-treatment of Hp infection can effectively cut off the transmission of Hp among members, reduce the recurrence rate and increase the cure rate
.
[Statement 11] For patients with gastric cancer or gastric mucosal precancerous lesions, family members living with them should be screened for Hp
.
Hp infection has typical family clustering characteristics, and Hp infection among first-degree relatives of gastric cancer patients usually has a higher risk of gastric mucosal lesions
.
[Statement 12] The treatment plan proposed in China's "Fifth National Consensus Report on the Treatment of Helicobacter Pylori Infection" is suitable for the eradication of H.
pylori in family members
.
(1) PPI + bismuth + 2 antibiotics China's "Fifth National Consensus Report on the Treatment of Helicobacter Pylori Infection" recommended a bismuth-containing quadruple plan (PPI + bismuth + 2 antibiotics) as the main empirical eradication of Hp The treatment plan (recommended 7 plans, Table 3), the treatment course is 10 or 14 days, these plans are currently widely used in clinical practice
.
Table 1 Recommended quadruple eradication program in China's "Fifth National Consensus Report on the Treatment of Helicobacter Pylori Infection" Note: PPI is a proton pump inhibitor
.
a refers to any of esomeprazole 20 mg, rabeprazole 10 or 20 mg, omeprazole 20 mg, lansoprazole 30 mg, pantoprazole 40 mg, and ilaprazole 5 mg Choose one
.
The resistance rates of metronidazole, clarithromycin, and levofloxacin were relatively high, while the resistance rates of amoxicillin, furazolidone and tetracycline were relatively low
.
Family members can choose the quadruple regimen with good curative effect and low adverse drug reaction rate
.
Because bismuth does not have drug resistance, short-term application safety is high, unless bismuth is contraindicated, the empirical treatment plan for eradication of Hp in China recommends the use of bismuth quadruple regimen as much as possible
.
(2) PPI+Amoxicillin Dual Therapy Recently, high-dose, high-frequency PPI+Amoxicillin dual therapy has also been initially reported.
This method is simple, easy to implement, and has good patient compliance.
Its Hp eradication rate is similar to quadruple therapy.
, But this program is not suitable for patients who are allergic to amoxicillin, and the past history of amoxicillin use may lead to potential drug resistance risks.
If possible, it can be selected based on the results of drug susceptibility tests.
Its efficacy in large-scale populations It remains to be further verified
.
(3) The new potassium ion pump blocker At the same time, the new potassium ion pump blocker has a strong inhibitory effect on gastric acid secretion, lasts for a long time, and is not affected by cytochrome P450 (CYP) 2C19 gene polymorphism The influence of serotonin provides a new option for improving the eradication rate of Hp
.
[Statement 13] The concept that Hp is eradicated for the first time is applicable to the treatment of Hp infection in family members
.
Choosing high-efficiency acid-suppressing PPI to increase the pH value in the stomach and increase the bioavailability of antibiotics can increase the eradication rate of H.
pylori
.
In recent years, with the widespread development of Hp eradication therapy in China, the resistance rate of Hp to antibiotics has gradually increased, and the eradication rate of empirical therapy has shown a downward trend
.
Failure of the first eradication can easily lead to the emergence of bacterial drug resistance, which will narrow the range of medication options for retreatment.
Therefore, it should be successfully eradicated as soon as possible at the first treatment
.
[Statement 14] The urea breath test, serum antibody test and stool antigen test are applicable to the Hp test of family members
.
[Statement 15] Measures to prevent Hp infection from the public and community levels should include comprehensive prevention and control with the family as a unit
.
[Statement 16] In the absence of an effective vaccine, prevention of newborn Hp infection and eradication of existing infections in family members are both relatively effective infection prevention and control strategies
.
Wonderful preview of the next issue of the guide ~ As many readers and friends expressed their interest in Hp related content, the editor hereby successfully invited the author of this consensus, Professor Ding Songze, chief physician of the Department of Gastroenterology, Zhengzhou University People's Hospital, to interpret the consensus
.
More exciting, please lock in the digestive liver disease channel of the medical community~ see you in the next issue! References: [1] Zhao H, Yan P, Zhang N, et al.
Helicobacter 2021 Sep 12.
The recurrence rate of Helicobacter pylori in recent 10 years: A systematic review and meta-analysis.
10.
1111/hel.
12852.
[2 ] National Center for Clinical Medicine of Digestive Diseases (Shanghai), National Alliance of Centers for Prevention and Treatment of Early Gastrointestinal Cancer, Helicobacter pylori and Peptic Ulcer Group of Chinese Society of Gastroenterology, etc.
Prevention of Helicobacter pylori infection in Chinese households Expert consensus on control and management (2021)[J].
Chinese Journal of Digestion,2021,41(4):221-233.
DOI:10.
3760/cma.
j.
cn311367-20210219-00108.
Source of this article: Medical Digestive Liver Disease Channel Author of this article: Yan Ni, review of this article: Yang Health, Deputy Chief Physician of Jingdezhen Second People’s Hospital Editor: XU Copyright Statement If the original text of this article needs to be reproduced, please contact for authorization-End-The medical community strives to be accurate and reliable when the content is reviewed and approved.
However, it does not make any promises or guarantees on the timeliness of the published content, as well as the accuracy and completeness of the cited information (if any), and does not assume that the content is out of date, and the cited information may be inaccurate or inaccurate.
Any liability arising from completeness and other circumstances
.
Relevant parties are requested to check separately when adopting or using this as a basis for decision-making
.
Contributions are welcome to submit to the editor’s mailbox: xh@yxj.
org.
cn.
Please specify: [Submission] Hospital + department + name Contributions are in the form of word documents, others will not be considered.
Editor’s WeChat: xupeiyu96
