Revised H. pylori guideline offers better treatment options

The Korean Journal of Internal Medicine has published a revised guideline to treat patients with H. pylori (H. pylori) developed by the Korean Helicobacter and Upper Gastrointestinal Research, accompanied by the recommendation of therapies.

The new version features updated clinical practice guidelines for H. pylori infection by conducting a meta-analysis to identify the clinical evidence for alternative treatments to the existing seven-day triple therapy.

(Credit: The Korea Journal of Internal Medicine)

Researchers reviewed the level of indication and strength of recommendation for first-line therapy in patients undergoing H. pylori eradication in the study. In addition, researchers have assessed the four regimens -- 14-day standard triple therapy, non-bismuth quadruple therapy, seven-day standard triple therapy after clarithromycin resistance test, quadruple bismuth therapy.

The level of indication was moderate or high for the first three treatment methods with a strong recommendation.

However, quadruple bismuth therapy was recommended as first-line therapy only when patients had no other options because of its high adverse effects.

The journal said that the guidelines were designed to provide patients, nurses, medical school students, policymakers, and clinicians with evidence for primary care and therapy of H. pylori infection.

The research team used web surveys to identify patients' experiences, expectations, and preferences for the recently introduced guideline.

Two hundred thirty-three subjects responded, and 64.4 percent of them were adult female, and 57.5 percent were H. pylori-positive. Among those with positive H. pylori response, 86.7 percent wanted treatment, and 44.6 percent of them specified the reason to prevent stomach cancer. The other 28.8 percent wanted to improve stomach symptoms, while 9.9 percent feared transmitting infections to other people.

H. pylori infection is one of the most common infectious diseases worldwide. It is responsible for substantial gastrointestinal morbidity with a high burden.

Since the revision of the H. pylori Clinical Practice Guidelines in 2013 in Korea, the eradication rate of H. pylori slowed using clarithromycin-based triple therapy has gradually fallen.

Many epidemiologic studies have shown the relationship between H. pylori and gastric cancer. Korea, Japan, and China, the countries with a high risk of gastric cancer, have shown an increase in the prevalence of H. pylori infection.

The standardized incidence of gastric cancer in Korea was 32.0 per 100,000 people in 2017, a leading cause of cancer second to thyroid cancer. According to the journal, effective measures for primary or secondary prevention of gastric cancer became a public health problem considering the high prevalence and high fatality in advanced gastric cancers.

Clinicians have widely used antibiotics, including clarithromycin for respiratory symptoms and levofloxacin for urinary infections, and this has increased patients' drug resistance for H. pylori therapy. Due to the dynamic changes of the H. pylori epidemiology and increasing antibiotics resistance, the medical society has called for a new approach for effective management.

"We believe that tailored therapy will be useful for resistance tests based on PCR or sequencing, widely used in clinical practice due to the convenience," researchers noted in their paper.

Although recommendations were made according to the resistance rate of Korea, implementing evidence-based medicine and using novel meta-analysis, they could be applied to countries in Far East Asia.