Canadian Helicobacter Study Group Consensus Conference: Update on the Management ofHelicobacter pylori- An Evidence-Based Evaluation of Six Topics Relevant to Clinical Outcomes in Patients Evaluated forH pyloriInfection

Abstract

As an update to previously published recommendations for the management of Helicobacter pylori infection, an evidence-based appraisal of six topics was undertaken in a consensus conference sponsored by the Canadian Helicobacter Study Group. The issues addressed and recommendations made were: bismuth-containing quadruple therapy is appropriate as an alternative first-line eradication strategy for H pylori infection; searching for and treating H pylori infection is warranted in patients considered to be at high risk for gastric cancer; H pylori infection should be eradicated before initiating long-term treatment with nonsteroidal anti-inflammatory drugs or acetylsalicylic acid; the stool antigen test has a limited role in the diagnosis of H pylori infection; the benefits of H pylori eradication in patients on long-term proton pump inhibitor therapy are not sufficient to warrant recommending a strategy of searching for and eradicating the infection among these patients; and a strategy of "test and eradicate" for H pylori infection in patients with uninvestigated dyspepsia is cost-effective in Canada relative to a trial of proton pump inhibitor therapy. The goal was to establish guidelines on the best evidence using the same structure to address and formulate recommendations for each issue. The degree of consensus for each issue is presented.

Gastric Cancer in Asian American Populations: a Neglected Health Disparity

“…However, individuals who contributed to the Asia Pacific consensus guidelines on gastric cancer prevention have suggested that guidelines for the identification and eradication of helicobacter pylori infection in Asia should be applied to Asian communities with high gastric cancer rates in Western countries (such as Korean immigrants to the US) . Additionally, Canadian Cancer Society guidelines already call for helicobacter pylori identification and eradication for Asian immigrants from high-risk countries (Canadian Cancer Society, 2014;Hunt et al, 2004). Both the physician data query screening and prevention editorial board and American society of gastrointestinal endoscopy have suggested that gastric cancer screening be considered for Asian immigrants from geographic areas with high gastric cancer incidence rates (American Society of Gastrointestinal Endoscopy, 2010;National Cancer Institute, 2014).…”

“…Both the Canadian helicobacter study group and Canadian Cancer Society recommend testing for and treating helicobacter pylori infection in immigrants from geographic areas of the world where the incidence of gastric cancer is high (Hunt et al, 2004;Canadian Cancer Society, 2014). The American Society of Gastrointestinal Endoscopy recognizes that helicobacter pylori identification and eradication has the potential to reduce the risk for gastric cancer in groups at high risk for the disease but does not suggest ethnicity-based deviations from usual care (American Society of Gastrointestinal Endoscopy, 2010; 2014).…”

Empiric therapies for Helicobacter pylori infections: Figure 1:

“…Initially, this was a highly successful regimen, but worldwide resistance to clarithromycin has been increasing, such that treatment success is now generally 80% or less ( Figure 1). [1][2][3][4] In this article, we discuss the choice of anti-H. pylori therapies in this era of increasing antimicrobial resistance.…”

Clinical Evaluation of Triple and Quadruple Helicobacter Pylori Eradication Therapy in Peptic Ulcer Patients With Different Abo Blood Group Phenotypes

“…Previous studies reported a success rate of >90% for bismuth-containing quadruple therapy in different parts of the world [74,75], and in Iraq [76] but, up to our knowledge, estimating the response rate and ulcer healing efficacy of H. pylori eradication according to ABO phenotypes is the first trial.…”