Subversive changes in the guidelines for the prevention and control of Helicobacter pylori infection?

*It is only for medical professionals to read for reference.
The answer is "If one person is infected, the whole family will be investigated and treated at the same time"! Summary of this article: 1.
How does Hp cause gastric cancer? How long after infection can cause stomach cancer? 2.
"One person is infected, the whole family gets sick", why is Hp so terrible? 3.
What are the advantages and disadvantages of Hp's "detection-treatment", "screening-treatment" and "family prevention and control" strategies? 4.
In addition to focusing on the intra-family transmission of Hp, what other highlights are there in this consensus? 5.
What good habits should Hp infected persons and their family members develop? This year, my country's Helicobacter pylori (Hp) academic circles have made big moves! Under the guidance and guidance of Academician Li Zhaoshen of the Chinese Academy of Engineering, the National Society of Gastroenterology, and the Hp Group, the National Gastrointestinal Disease Clinical Medicine Research Center (Shanghai), the National Alliance of Gastrointestinal Early Cancer Prevention and Treatment Centers, and the Chinese Medical Association Gastroenterology Branch Helicobacter pylori In collaboration with the Peptic Ulcer Science Group, the National Helicobacter Pylori Research Collaboration Alliance and other organizations, more than 50 top experts in related majors in China worked together to discuss and formulate the "Chinese Resident Family Helicobacter Pylori" between April and April this year.
Expert consensus on the prevention, control and management of bacterial infections (2021)
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This consensus is the first at home and abroad to propose the prevention and control of Hp with the family as a unit.
This is a more practical Hp prevention strategy that is in line with China's national conditions, has strong operability, and is also the crystallization of the wisdom of Chinese experts.
It is adding strong color to the prevention and control of Hp in China.
At the same time, it also sent a resounding voice of China to the international academic stage, demonstrating Chinese wisdom
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In order to convey to the general public and fellow medical scholars and colleagues in more depth the essence of the consensus and more wise insights beyond the consensus, the medical community hereby invites the author and co-corresponding author of the consensus, Zhengzhou University People’s Hospital (People’s Hospital of Henan Province) Hospital) Professor Ding Songze, chief physician of the Gastroenterology Department, was interviewed
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Interview with Professor Ding Songze, Five Questions and Answers 1.
How does Hp cause gastric cancer? How long does it take to cause stomach cancer after infection? Professor Ding Songze replied that as early as 1994, the WHO had defined Hp as a type I carcinogen (a clear carcinogen), and up to 90% of gastric cancer patients were also accompanied by Hp infection
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After being infected with Hp, all infected people will develop chronic gastritis of varying degrees, some of which are accompanied by gastric mucosal erosion; after that, about 10% of Hp infected people will cause atrophic gastritis and intestinal metaplasia, this step already represents the appearance Precancerous lesions; eventually about 1% of infected people develop gastric cancer
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Fig.
1 Chronic gastritis-gastric mucosal atrophy-intestinal metaplasia-gastric cancer pathway caused by Hp Professor Ding Songze pointed out that before Hp infection develops into gastric mucosal precancerous lesions, it is generally believed that it takes at least 5-10 years of chronic inflammation
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Most of the patients were infected with Hp in childhood, and a small number of infected patients developed precancerous lesions after a certain period of time, and then continued to develop into gastric cancer
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In recent years, clinical observations at home and abroad have found that up to 4%-10% of children and adolescents with Hp infection have found pathological precancerous lesions in the gastric mucosa, which is an important aspect that has been neglected in the past
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Therefore, in areas with high Hp infection rates, the occurrence of gastric mucosal precancerous lesions in children and adolescents may be earlier and more common than we thought, and serious attention is needed
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2.
"One person is infected, the whole family gets sick", why is Hp so terrible? Hp has the characteristics of oral transmission, and the infection has obvious family gathering phenomenon, which can be transmitted from person to person and between family members
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In addition, some of the unique hygiene and eating habits of our country have created extremely favorable conditions for the transmission of Hp within the family, such as: ① chewing food for children ② eating a bowl of dishes for a family meal ③ seldom use chopsticks and spoons ④ Unsanitary drinking water source When asked about the specific risk of infection by other family members if a family member is infected, Professor Ding Songze responded that “the risk is still considerable”, this is because: ①The living habits and living habits of relatives There are genetic similarities.
One person is infected, which means that other people are also susceptible.
② Living together is more conducive to the spread of harmful bacteria, Hp
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Later, Professor Ding Songze showed to the medical community the results of a small-scale epidemiological survey conducted by his research team in Zhengzhou area.
About 88% of the surveyed households in Zhengzhou area had at least one person infected.
Among the households infected with Hp, " "One person is infected, the whole family gets sick" accounted for about 28% of the families
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If you want to have a deeper understanding of this issue, a large-scale epidemiological survey involving 10,000 families across the country under the guidance of Academician Li Zhaoshen is currently underway, and the results of the study can be expected within 1 to 2 years
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Professor Ding Songze once again emphasized, “Due to the characteristics of oral transmission, intra-family transmission is an important cause of Hp infection.
When a family member is found to be positive for Hp, other people should also be aware of the possibility of Hp infection and the whole family as soon as possible.
Check to prevent this bacteria from "rooting and sprouting" at home, causing "one person to be infected and the whole family to get sick "
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"What are the advantages of 3.
Hp's "detection-treatment", "screening-treatment" and "family prevention and control" strategies inferior? ① "Detection-treatment" strategy Because of the low infection rate, different dietary habits and other aspects, Western countries generally adopt the "detection-treatment" strategy, that is, the strategy of "not actively detect, but treat if found".
This strategy is used Uninvestigated young patients with dyspeptic symptoms, but not suitable for patients with alarm symptoms and older patients, nor suitable for areas with high Hp infection rate and high incidence of gastric cancer
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②Screening-treatment strategy countries with high Hp infection rates, such as China and some countries and regions in Asia, the Middle East, and Latin America generally adopt the “screening-treatment” strategy, that is, “check it first, and treat it if you find it” This strategy is suitable for patients with family history of gastric cancer, old age, and alarm symptoms, but not suitable for areas with low Hp infection rate
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③"Family prevention and control" strategy "Family prevention and control" strategy was first proposed by Chinese scholars , Is to screen, treat and follow up family members while targeting the prevention and treatment of Hp infection in the family.
The applicable area is not affected by the Hp infection rate and the incidence of gastric cancer
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④Expert comments Professor Ding Songze pointed out, "The first two The strategies are all put forward by experts and scholars in Western countries, only to treat the patients themselves, for the prevention and treatment of infected people in different regions
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However, due to the vast territory of our country and the generally high infection rate, it is difficult to find out the low incidence areas from the high Hp infection rate areas in the whole country, and then use the above strategies to treat patients separately
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"The'family prevention and control' strategy not only pays attention to the patients visiting the clinic, but also pays attention to the infection of other family members and the progress of the precancerous lesions of the gastric mucosa of the infected person.
It is a kind of practical Hp that is in line with China's national conditions.
An important strategy for prevention and control
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Thanks to the cooperation and testing of family members, it is also possible to give full play to the initiative of family members to care for each other without increasing government input, resulting in an effect similar to the eradication of the whole people
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"4.
In addition to focusing on the transmission of Hp within the family, compared with the previous consensus in China, what other highlights and possible far-reaching impacts of this consensus? Different from the previous consensus in China, this consensus is based on family, prevention and control, and The three aspects of management are not only for medical professionals, but also for non-professional social personnel, and give full play to the subjective initiative of family members to care for each other, and improve the compliance of patients and their families in medical treatment
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The significance of the consensus lies in: ①For practitioners in the medical industry: Improve the concept of Hp prevention and treatment-from treating only a single patient to paying attention to and preventing and treating the patient's entire family, it will help eliminate the source of infection from the root cause and reduce the recurrence or reinfection of patients ②For the family: improve the bad hygiene and eating habits in the family, help promote the sharing of meals, public chopsticks and spoons, prevent the occurrence of new infections and actively treat infected family members; ③for the society: increase people’s awareness of Hp It is also in line with the national strategy of “health for all” advocated by our country
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As mentioned above, it can also produce an effect similar to the eradication of the whole people without increasing government input
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If the public and relevant government departments pay enough attention to Hp, I believe it can indirectly promote the development of Hp vaccine and increase investment in other scientific research and innovation
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Professor Ding Songze also added that due to the increase in the number of treatments, the population’s antibiotic resistance may increase, and refractory cases may increase.
This is a problem worthy of attention.
At the same time, it should also be addressed that society may form within a certain period of time after the consensus is promoted.
Actively relieve and prevent the "phobia of phantom"
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5.
What good habits should Hp infected persons and their families develop? Hp is a typical "disease from the mouth" disease.
In the process of prevention and treatment, people still need to pay attention to many aspects of their life>
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Clinicians should also remind patients of their responsibility to inform family members when receiving patients with Hp infection.
Community doctors and family doctors should also correctly guide the public when carrying out health education and education, and promote the concept of "family-based prevention and control of Hp"
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On the other hand, we should also avoid exaggerating the harm, causing the whole family of residents to produce "fear of seclusion," affecting normal family and social life
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Summary: Hp is a class I carcinogen, which can cause gastric cancer
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China is an area with a high incidence of Hp infection.
Intra-family transmission is an important cause of Hp infection in the population
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There are many cases where "one person is infected and the whole family gets sick" .

If we want to control infection from the source, we must pay attention to the prevention and control of infection in the family
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This not only requires the efforts of clinicians, but also requires people from all walks of life to participate more actively, to develop good habits when eating, and to cultivate the awareness of "one person is infected, the whole family is treated at the same time"
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In the end, Professor Ding Songze not only expressed his expectation for the residents of our country to have "no (secure) worry" for the whole family", but also expressed the good vision of extending our country's advanced experience in this area to other countries and regions in the world in the future
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 Expert profile Ding Songze Ding Songze, male, doctor of medicine, returned scholar from the United States, chief physician of the Department of Gastroenterology, Zhengzhou University People's Hospital (Henan Provincial People's Hospital)
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Member of the Standing Committee of the Digestive Disease Professional Committee of the Chinese Medical Education Association, member of the Helicobacter pylori and Ulcer Disease Group of the Digestive Disease Branch of the Chinese Medical Association, member of the Expert Committee of the Chinese Helicobacter Pylori Information Center Network; The 7th Digestive Disease Branch of the Henan Medical Association Member of the Standing Committee and deputy head of the Helicobacter pylori and microecology group, and deputy director of the Henan Province Helicobacter Pylori Infection Diagnosis and Treatment Alliance
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He has studied and taught in internationally renowned universities such as the University of Texas, the University of Virginia and Hokkaido University in Japan
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In May 2013, he was introduced by the Henan Provincial People's Hospital/Zhengzhou University People's Hospital as overseas scholars and returned to work in China
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He is currently an editorial board member of 8 international professional journals, and has reviewed manuscripts for more than 30 international journals as a peer expert
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Engaged in clinical medical treatment, scientific research and teaching of digestive system diseases for more than 20 years
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Good at diagnosis and treatment of common and difficult diseases of the digestive system
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References: [1] Reading and free download link of "Expert Consensus on Prevention, Control and Management of Helicobacter Pylori Infection in Chinese Resident Families (2021)" in Chinese Journal of Digestion: http://rs.
yiigle.
com/CN311367202104/1318628.
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