ABSTRACT
Helicobacter pylori (Hp) infection is an infectious disease with a prevalence rate of up to 50% worldwide. It can cause dyspepsia, gastritis, peptic ulcer disease and gastric cancer. Hp eradication treatment can effectively control disease progression and reduce risk of the diseases. However, the escalating trend of antibiotic resistance presents a global challenge for Hp eradication. Though decreasing in developed countries, the prevalence of Hp infection remains high in developing countries, causing a major public health burden. This clinical practice guideline (CPG) is made to provide guidance on the eradication treatment of Hp infection. This CPG is developed following the World Health Organization’s recommended process, adopting grading of recommendations assessment, development, and evaluation (GRADE) in assessing evidence quality and utilizing its evidence to decision framework to formulate clinical recommendations, so as to minimize bias and increase transparency of the CPG development process. The Reporting Items for Practice Guidelines in Healthcare (RIGHT) statement and Appraisal of Guidelines for Research and Evaluation II (AGREE II) are used as reporting and execution guidance to ensure its completeness and transparency. This CPG contains 12 recommendations concerning eradication treatment of Hp infection. Among them, it is worth highlighting that bismuth preparations are safe, effective and inexpensive, consequently making bismuth quadruple therapy a preferred choice for initial and rescue treatments. In empirical initial treatment, high dose dual therapy is equally effective as bismuth quadruple therapy. The 12 recommendations in this CPG are formed with consideration to stakeholders’values and preferences, resource availability, feasibility and acceptability. These recommendations are generally applicable to resource limited settings with similar antibiotic resistance pattern as China, and status with comparable sociological and technical challenges.
ABSTRACT
Background: The benefits and risks of eradicating Helicobacter pylori (Hp) should be balanced in aged people. Aims: To investigate the efficacy, safety and antibiotic resistance status of Hp eradication treatment in the elderly. Methods: Four cohorts of subjects who received Hp eradication treatment in randomized controlled trials conducted in Chongqing Daping Hospital were reviewed; the demographic and clinical data were extracted and recorded. Propensity score matching was performed to select comparable elderly group (≥60 years old) and non-elderly group (0.05). Furthermore, there were no significant differences in the Hp eradication rates in terms of gender, cigarette smoking, alcohol consumption, comorbidities (hypertension, diabetes, surgical history, and inflammation), compliance, etc. in the elderly group (all P> 0.05). But in retreated elderly subjects, the resistance rate of clarithromycin was higher than that in naïve elderly subjects (P<0.05). Smoking and poor compliance were identified as independent risk factors for Hp eradication by multivariate Logistic regression analysis. Conclusions: Hp eradication in the elderly demonstrates comparable efficacy and safety with non-elderly subjects. Clarithromycin-containing regimens are not recommended for empirical retreatment in aged people.
ABSTRACT
The standard therapy for Helicobacter pylori eradication consists of double antibiotics and proton pumb inhibitors. In recent years, due to bacterial resistance and adverse events of therapy, the percentage of eradication failure is rising. Several studies have showed that the role of probiotics in the treatment of H. pylori infection as a complement to antibiotics or potential supplement to reduce adverse effects. In animal studies, probiotics such as Lactobacilus inhibited H. pylori induced gastric inflammation. The results of randomized, double-blind, placebo-controlled studies suggest that specific probiotic strains, such as Sacchromyces boulardii and Lactobacillus johnsonni may reduce H. pylori load in the stomach and be helpful increasing eradication rates. Furthermore, probiotic supplmentation can reduce adverse effects induced by antiboitics treatment, and have beneficial effects H. pylori infected individuals.