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Only for medical professionals to read and reference Hp is one of the “culprits” of gastric cancer.
All people infected with Hp should receive eradication treatment.
According to the global tumor epidemiological statistics (GLOBOCAN 2018), it is estimated [1] that gastric cancer is still the fifth most common cancer and the third leading cause of cancer death.
Among them, the countries with the most new cases each year are China, Japan, India and South Korea.
Although, with the advancement of medical care, the incidence of gastric cancer is expected to decrease in the next 20 years, but the aging of the population will lead to a further increase in the number of patients.
Helicobacter pylori (Hp) is an important public health problem on a global scale, affecting billions of people, and is listed as a Class I carcinogen by the World Health Organization (WHO).
There is no doubt that existing evidence has confirmed that eradication of Hp can reduce the risk of gastric cancer in infected people.
However, how to transform this basic and clinical knowledge into public health intervention measures, through the whole population "screening and eradicating" Hp, and ultimately preventing the spread of gastric cancer in the world, there is still a big gap in this regard.
To this end, 28 experts from 11 countries reviewed relevant evidence and formulated the "Screening and eradicating Helicobacter pylori to prevent gastric cancer: Taipei Global Consensus" [2], promoting strategies for eradicating Hp and preventing gastric cancer, and proposing all Collaborative research on population screening and eradication of Hp to prevent gastric cancer.
This consensus was published in Gut magazine in October 2020.
The consensus points out that the evidence supports the recommendation that all people infected with Hp should receive eradication treatment.
High-risk groups should be tested, and if they test positive, they should be eradicated.
Large-scale screening and eradication of Hp should be considered in high-risk groups of gastric cancer.
Eradication of Hp to prevent gastric cancer is feasible and the eradication treatment is highly safe.
The full text presents a total of 26 clinical issues in 5 parts, which is of great guiding value.
1.
The burden of gastric cancer related to Hp infection.
Although the age-standardized incidence and mortality of gastric cancer are declining globally, the number of new gastric cancer cases remains high due to the increase in the elderly population.
As the main cause of gastric cancer, although the Hp infection rate in most western countries has shown a downward trend, it still remains high in the high-risk population of gastric cancer.
Among them, the infection rate of Hp in children has fallen below 10% in some populations, but it is still high in many parts of the world.
Worldwide, the attributable fraction of Hp in gastric cancer is >85%, which indicates that if Hp infection is eliminated from the population, most gastric cancers can be prevented.
Eradication of Hp can reduce the risk of gastric cancer in patients with Hp infection.
Because eradication of Hp can reduce the risk of metachronous gastric cancer, it is still recommended to eradicate Hp after resection of early gastric cancer.
2.
At the population level, the feasibility of implementing Hp screening and eradication programs.
It is proposed that in high-incidence or high-risk groups of gastric cancer (for example, first-degree relatives of gastric cancer patients), Hp "screening and treatment" strategy is recommended to prevent gastric cancer.
It is also recommended to screen and eradicate Hp before the occurrence of atrophic gastritis and intestinal metaplasia.
For young adults in areas with a high incidence of gastric cancer, screening and treatment of Hp infection is the most cost-effective strategy to prevent gastric cancer.
Young people benefit the most from Hp eradication, in addition to curing Hp-related gastritis, reducing the risk of gastric cancer, and reducing the chance of transmission to their children.
Urea breath test and Hp stool antigen test are the preferred methods for large-scale screening, but locally validated Hp serological tests can also be considered.
For patients with high-risk Hp infection for gastric cancer, it is recommended that they undergo gastroscopy.
3.
Principles of Hp treatment in large-scale eradication plans. We have seen an increasing trend of people's resistance to clarithromycin and levofloxacin worldwide.
Therefore, when choosing the best treatment plan for the community, the drug resistance, efficacy, adverse reactions and cost of Hp in different regions should be considered.
It is recommended to monitor the antibiotic resistance rate of Hp in the local area to determine the best empirical treatment plan for large-scale eradication of Hp in this population.
The consensus emphasizes that the recurrence rate after large-scale eradication of Hp is very low.
In the large-scale screening, the confirmation test of Hp is not mandatory, but the confirmation test should be performed on the population who has received Hp eradication treatment to evaluate the treatment effect.
4.
Eradicate the potential adverse effects of Hp treatment.
As with all antibiotic treatments, eradication of Hp may lead to an increase in antibiotic resistance, but this should not hinder its use in the treatment of gastric cancer.
Studies have proved that the standardized eradication of Hp will not bring about adverse consequences.
Publicity should be strengthened to understand the hazards of Hp infection and reduce the public’s fear of eradicating Hp.
This point is consistent with the "Expert Consensus Opinions on Helicobacter Pylori Eradication and Gastric Cancer Prevention and Control in China" published in my country in 2019 [3].
The consensus points out that after Hp eradication, the diversity of the fecal microbiota will undergo a short-term disturbance, and then it will basically recover.
Eradication of Hp does not increase the risk of new onset and recurrence of gastroesophageal reflux disease.
Although eradication therapy may be related to a small increase in body weight, it does not increase the risk of metabolic syndrome.
Eradication of Hp will not increase the risk of asthma, inflammatory bowel disease and other immune-related diseases in adults.
5.
Endoscopic follow-up of gastric cancer after Hp eradication.
Patients with advanced gastric mucosal atrophy or intestinal metaplasia should undergo endoscopic monitoring to detect gastric cancer after Hp eradication.
For patients with advanced gastric mucosal atrophy or intestinal metaplasia, endoscopic monitoring is recommended every 2 to 3 years; for patients after mucosal neoplasia, it is recommended to check every 12 months.
Finally, the consensus pointed out that genetic and epigenetic markers have shown promise in gastric cancer risk stratification after Hp eradication, but they still need to be further verified in prospective studies.
The guiding significance of the "Taipei Global Consensus" for the eradication of Hp and the prevention of gastric cancer in my country.
The current Hp infection rate in China is 40% to 60% [4], and all age groups are susceptible to Hp, especially young people still have high Hp Infection rate [5].
The release of the Taipei Global Consensus once again supports the possibility and feasibility of carrying out large-scale screening and eradication of H.
pylori to prevent gastric cancer in my country.
The clinical trials of the seven empirical treatments for Hp eradication recommended by the consensus in my country all use a course of 10 to 14 days, and the eradication rate is >90% [6].
Among them, adequate acid suppression treatment is essential for the eradication of Hp.
Studies have shown that when the 24-hour median pH>6 [7], most patients can be successfully eradicated, regardless of whether Hp is sensitive to clarithromycin.
However, as an acid suppressant in the Hp eradication program, proton pump inhibitors (PPI) have many limitations and are difficult to meet the needs of antibacterial.
The development of acid-suppressing drugs with stronger acid-suppressing effect and capable of overcoming the limitations of PPI itself is of great significance for improving the eradication rate of Hp and promoting the eradication of Hp to prevent gastric cancer.
References: 1.
Bray F, Ferlay J, Soerjomataram I, et al.
Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.
CA Cancer J Clin 2018;68:394–424.
2.
Liou JM , et al.
Screening and eradication of Helicobacter pylori for gastric cancer prevention: the Taipei global consensus.
Gut 2020; 0:1-20.
doi:10.
1136/gutjnl-2020-322368.
3.
National Digestive Diseases-Clinical Medicine Research Center (Shanghai ) Etc.
Expert consensus on the eradication of Helicobacter pylori and the prevention and control of gastric cancer in China (2009, Shanghai).
Chinese Journal of Digestion.
2019, 39(5): 310-316.
4.
Wan Dai, Hu Fulian, Xiao Shudong et al.
Epidemiological survey of Helicobacter pylori infection in natural populations in China [J].
Modern Digestion and Interventional Diagnosis and Treatment, 2010, 15(5):265-270.
5.
Xie C, Lu NH.
Review: clinical management of Helicobacter pylori infection in China[J].
Helieobaeter, 2015, 20(1): 1-10.
6.
Helicobacter pylori and peptic ulcer group, Chinese Society of Digestive Diseases, National Helicobacter Pylori Research Cooperative Group.
The fifth national consensus on Helicobacter pylori infection management Report.
Chinese Journal of Digestion.
2017, 37(6):364-378.
7.
Sugimoto M, et al. If you are not a medical and health professional, please do not participate or spread it.
-End-
All people infected with Hp should receive eradication treatment.
According to the global tumor epidemiological statistics (GLOBOCAN 2018), it is estimated [1] that gastric cancer is still the fifth most common cancer and the third leading cause of cancer death.
Among them, the countries with the most new cases each year are China, Japan, India and South Korea.
Although, with the advancement of medical care, the incidence of gastric cancer is expected to decrease in the next 20 years, but the aging of the population will lead to a further increase in the number of patients.
Helicobacter pylori (Hp) is an important public health problem on a global scale, affecting billions of people, and is listed as a Class I carcinogen by the World Health Organization (WHO).
There is no doubt that existing evidence has confirmed that eradication of Hp can reduce the risk of gastric cancer in infected people.
However, how to transform this basic and clinical knowledge into public health intervention measures, through the whole population "screening and eradicating" Hp, and ultimately preventing the spread of gastric cancer in the world, there is still a big gap in this regard.
To this end, 28 experts from 11 countries reviewed relevant evidence and formulated the "Screening and eradicating Helicobacter pylori to prevent gastric cancer: Taipei Global Consensus" [2], promoting strategies for eradicating Hp and preventing gastric cancer, and proposing all Collaborative research on population screening and eradication of Hp to prevent gastric cancer.
This consensus was published in Gut magazine in October 2020.
The consensus points out that the evidence supports the recommendation that all people infected with Hp should receive eradication treatment.
High-risk groups should be tested, and if they test positive, they should be eradicated.
Large-scale screening and eradication of Hp should be considered in high-risk groups of gastric cancer.
Eradication of Hp to prevent gastric cancer is feasible and the eradication treatment is highly safe.
The full text presents a total of 26 clinical issues in 5 parts, which is of great guiding value.
1.
The burden of gastric cancer related to Hp infection.
Although the age-standardized incidence and mortality of gastric cancer are declining globally, the number of new gastric cancer cases remains high due to the increase in the elderly population.
As the main cause of gastric cancer, although the Hp infection rate in most western countries has shown a downward trend, it still remains high in the high-risk population of gastric cancer.
Among them, the infection rate of Hp in children has fallen below 10% in some populations, but it is still high in many parts of the world.
Worldwide, the attributable fraction of Hp in gastric cancer is >85%, which indicates that if Hp infection is eliminated from the population, most gastric cancers can be prevented.
Eradication of Hp can reduce the risk of gastric cancer in patients with Hp infection.
Because eradication of Hp can reduce the risk of metachronous gastric cancer, it is still recommended to eradicate Hp after resection of early gastric cancer.
2.
At the population level, the feasibility of implementing Hp screening and eradication programs.
It is proposed that in high-incidence or high-risk groups of gastric cancer (for example, first-degree relatives of gastric cancer patients), Hp "screening and treatment" strategy is recommended to prevent gastric cancer.
It is also recommended to screen and eradicate Hp before the occurrence of atrophic gastritis and intestinal metaplasia.
For young adults in areas with a high incidence of gastric cancer, screening and treatment of Hp infection is the most cost-effective strategy to prevent gastric cancer.
Young people benefit the most from Hp eradication, in addition to curing Hp-related gastritis, reducing the risk of gastric cancer, and reducing the chance of transmission to their children.
Urea breath test and Hp stool antigen test are the preferred methods for large-scale screening, but locally validated Hp serological tests can also be considered.
For patients with high-risk Hp infection for gastric cancer, it is recommended that they undergo gastroscopy.
3.
Principles of Hp treatment in large-scale eradication plans. We have seen an increasing trend of people's resistance to clarithromycin and levofloxacin worldwide.
Therefore, when choosing the best treatment plan for the community, the drug resistance, efficacy, adverse reactions and cost of Hp in different regions should be considered.
It is recommended to monitor the antibiotic resistance rate of Hp in the local area to determine the best empirical treatment plan for large-scale eradication of Hp in this population.
The consensus emphasizes that the recurrence rate after large-scale eradication of Hp is very low.
In the large-scale screening, the confirmation test of Hp is not mandatory, but the confirmation test should be performed on the population who has received Hp eradication treatment to evaluate the treatment effect.
4.
Eradicate the potential adverse effects of Hp treatment.
As with all antibiotic treatments, eradication of Hp may lead to an increase in antibiotic resistance, but this should not hinder its use in the treatment of gastric cancer.
Studies have proved that the standardized eradication of Hp will not bring about adverse consequences.
Publicity should be strengthened to understand the hazards of Hp infection and reduce the public’s fear of eradicating Hp.
This point is consistent with the "Expert Consensus Opinions on Helicobacter Pylori Eradication and Gastric Cancer Prevention and Control in China" published in my country in 2019 [3].
The consensus points out that after Hp eradication, the diversity of the fecal microbiota will undergo a short-term disturbance, and then it will basically recover.
Eradication of Hp does not increase the risk of new onset and recurrence of gastroesophageal reflux disease.
Although eradication therapy may be related to a small increase in body weight, it does not increase the risk of metabolic syndrome.
Eradication of Hp will not increase the risk of asthma, inflammatory bowel disease and other immune-related diseases in adults.
5.
Endoscopic follow-up of gastric cancer after Hp eradication.
Patients with advanced gastric mucosal atrophy or intestinal metaplasia should undergo endoscopic monitoring to detect gastric cancer after Hp eradication.
For patients with advanced gastric mucosal atrophy or intestinal metaplasia, endoscopic monitoring is recommended every 2 to 3 years; for patients after mucosal neoplasia, it is recommended to check every 12 months.
Finally, the consensus pointed out that genetic and epigenetic markers have shown promise in gastric cancer risk stratification after Hp eradication, but they still need to be further verified in prospective studies.
The guiding significance of the "Taipei Global Consensus" for the eradication of Hp and the prevention of gastric cancer in my country.
The current Hp infection rate in China is 40% to 60% [4], and all age groups are susceptible to Hp, especially young people still have high Hp Infection rate [5].
The release of the Taipei Global Consensus once again supports the possibility and feasibility of carrying out large-scale screening and eradication of H.
pylori to prevent gastric cancer in my country.
The clinical trials of the seven empirical treatments for Hp eradication recommended by the consensus in my country all use a course of 10 to 14 days, and the eradication rate is >90% [6].
Among them, adequate acid suppression treatment is essential for the eradication of Hp.
Studies have shown that when the 24-hour median pH>6 [7], most patients can be successfully eradicated, regardless of whether Hp is sensitive to clarithromycin.
However, as an acid suppressant in the Hp eradication program, proton pump inhibitors (PPI) have many limitations and are difficult to meet the needs of antibacterial.
The development of acid-suppressing drugs with stronger acid-suppressing effect and capable of overcoming the limitations of PPI itself is of great significance for improving the eradication rate of Hp and promoting the eradication of Hp to prevent gastric cancer.
References: 1.
Bray F, Ferlay J, Soerjomataram I, et al.
Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.
CA Cancer J Clin 2018;68:394–424.
2.
Liou JM , et al.
Screening and eradication of Helicobacter pylori for gastric cancer prevention: the Taipei global consensus.
Gut 2020; 0:1-20.
doi:10.
1136/gutjnl-2020-322368.
3.
National Digestive Diseases-Clinical Medicine Research Center (Shanghai ) Etc.
Expert consensus on the eradication of Helicobacter pylori and the prevention and control of gastric cancer in China (2009, Shanghai).
Chinese Journal of Digestion.
2019, 39(5): 310-316.
4.
Wan Dai, Hu Fulian, Xiao Shudong et al.
Epidemiological survey of Helicobacter pylori infection in natural populations in China [J].
Modern Digestion and Interventional Diagnosis and Treatment, 2010, 15(5):265-270.
5.
Xie C, Lu NH.
Review: clinical management of Helicobacter pylori infection in China[J].
Helieobaeter, 2015, 20(1): 1-10.
6.
Helicobacter pylori and peptic ulcer group, Chinese Society of Digestive Diseases, National Helicobacter Pylori Research Cooperative Group.
The fifth national consensus on Helicobacter pylori infection management Report.
Chinese Journal of Digestion.
2017, 37(6):364-378.
7.
Sugimoto M, et al. If you are not a medical and health professional, please do not participate or spread it.
-End-
