2022 Chinese national clinical practice guideline on Helicobacter pylori eradication treatment

Abstract

Background: Helicobacter pylori (H. pylori) infection is an infectious disease with a prevalence rate of up to 50% worldwide. It can cause indigestion, gastritis, peptic ulcer, and gastric cancer. H. pylori eradication treatment can effectively control disease progression and reduce the risk of the above conditions. However, the escalating trend of antibiotic resistance presents a global challenge for H. pylori eradication. We aim to provide guidance on pharmacological treatment of H. pylori infection. Methods: This clinical practice guideline is developed following the World Health Organization's recommended process, adopting Grading of Recommendations Assessment, Development and Evaluation in assessing evidence quality, and utilizing Evidence to Decision framework to formulate clinical recommendations, minimizing bias and increasing transparency of the clinical practice guideline development process. We used the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement and The Appraisal of Guidelines for Research and Evaluation II (AGREE II) as reporting and conduct guides to ensure the guideline's completeness and transparency. Results: Though decreasing in developed countries, the prevalence of H. pylori remains high in developing countries, causing a major public health burden. This clinical practice guideline contains 12 recommendations concerning pharmacological treatment for H. pylori eradication. Among them, it is worth highlighting that bismuth preparations are inexpensive, safe, and effective, consequently making bismuth quadruple therapy a preferred choice for initial and rescue treatment. In empirical treatment, highdose dual therapy is equally effective compared with bismuth quadruple therapy. Conclusions: The 12 recommendations in this clinical practice guideline are formed with consideration for stakeholders' values and preferences, resource use, feasibility, and acceptability. Recommendations are generalizable to resource limited settings with similar antibiotic resistance pattern as China, and lower middle-income countries facing comparable sociological and technical challenges.

Dual therapy for Helicobacter pylori infection

“…Among them, HDDT was considered a promising treatment that can reduce the unnecessary use of antibiotics. In fact, 2022 Chinese national clinical practice guideline on Helicobacter pylori eradication treatment [ 3 ] recommends high-dose DT for H. pylori eradication. In 2021, a meta-analysis examined 41 RCTs with 14,119 patients.…”

“…2022 Chinese national clinical practice guideline on Helicobacter pylori eradication treatment [ 3 ] recommends high-dose DTs for H. pylori eradication for the first time. Previously, BQT had been consistently recommended.…”

“…2022 Chinese national clinical practice guideline on Helicobacter pylori eradication treatment [ 3 ] recommends bismuth-containing quadruple therapy (BQT), which consists of an acid suppressor, two antibiotics, and a bismuth agent, as the primary and rescue treatment. Moreover, dual therapy (DT), which consists of an acid suppressor and amoxicillin, is also recommended for people without penicillin allergy.…”

Colloidal bismuth pectin‐containing quadruple therapy as the first‐line treatment of Helicobacter pylori infection: A multicenter, randomized, double‐blind, non‐inferiority clinical trial

“…BPC was used to be the control because of its wide use and high efficacy. 21 In the ITT and PP populations, high efficacy (>90%) was achieved by both group and CBP quadruple therapy was non-inferior to BPC quadruple therapy. The efficacy of CBP or BPC quadruple therapy for 14 days was higher than that in our previous study, 16 which might be explained by the extended duration of regimen.…”

“…As recommended by the 2022 Chinese national clinical practice guideline on Helicobacter pylori eradication treatment, five antibiotic combinations could be used in bismuth quadruple therapy. 21 Among them, the prevalence of H. pylori resistant to amoxicillin and tetracycline was relatively low and remained unchanged. 10,24 In our previous meta-analysis focusing on the combination of amoxicillin and tetracycline for eradicating H. pylori, quadruple therapy for 10 and 14 days achieved 93.7% and 89.0% pooled eradication rate according to PP analysis although the limited studies were included.…”