Hellenic consensus on Helicobacter pylori infection

Abstract

The Hellenic Society of Gastroenterology recently organized the "Hellenic consensus on Helicobacter pylori (H. pylori) infection". The aim of this publication is to report the guidelines in order to aid the national gastroenterology community in the management of H. pylori infection. Forty-one delegates from all Greek regions, including gastroenterologists, pathologists, clinical microbiologists, epidemiologists and basic scientists, were invited to this meeting. The participants were allocated to 1 of the 4 main topics of the meeting: i.e., H. pylori diagnosis and association with diseases; H. pylori and gastric cancer; H. pylori and extragastric associated disorders; and H. pylori treatment. The results of each subgroup were submitted to a final consensus vote that included all participants. Relevant data based on international and Greek publications were presented, and the quality of evidence, strength of recommendation, and level of consensus were graded. The cutoff level of 70% was considered as acceptance for the final statement. It is hoped that the recommendations and conclusions of this report will guide Greek doctors in their daily practice concerning the management of H. pylori infection.

Authors’ reply

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We read with great interest the letter by Papaefthymiou et al [1] concerning the Greek National Consensus on Helicobacter pylori (H. pylori) infection [2]. We certainly agree with the authors that over the past years in order to overcome the fast-growing antibiotic resistance of H. pylori infection worldwide, an "add-on" strategy has been adapted, and that this is more obvious in countries like Greece, where bismuth salts are not commercially available.

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Correlation of registered drug packs in Greece with Maastricht V/Florence and Hellenic Helicobacter pylori infection treatment consensuses: A poor or a proper match?

“…The 10-day levofloxacin-containing regimen, proposed as the preferred second-line salvage option in Greece, 3 matches almost properly for the PPI (1 bt of 28 tbs wasting 8 tbs), perfectly for the levofloxacin (placed on the market as a 5 tbs per bt) though poorly for the amoxicillin (wasting 16 tbs). Extending the latter option to 14 days would show a perfect match wasting 2 tbs of PPI, 8 tbs of amoxicillin and 1 tb of levofloxacin.…”

“…1 Our own study 2 recently estimated the economic cost per Hp-I eradication treatment in Greece, a small market country with high clarithromycin resistance, using all the proposed non-bismuth eradication regimens according to European and national guidelines and suggesting that the economic pillar should be taken into account by the national health policymakers. 3,4 In Greece, according to the national policy on drug disposal, pharmacies provide drugs in packages instead of the precise necessary quantity. Regarding the 10-day concomitant regimen, proposed as the preferred first-line treatment option in Greece 3 and taking into account that bismuth salts, tetracycline or the combination drug ("Pylera") are not commercially available, 20 tablets (tbs) of (a) a proton-pump inhibitor (PPI), (b) amoxicillin 1 g, (c) clarithromycin 500 mg and (d) metronidazole 500 mg are regularly prescribed.…”

“…The 10to 14-day standard triple and the 10-day sequential regimens exhibit unacceptable eradication rates in Greece, thereby no longer recommendable based on local antibiotic resistance susceptibility data. 3 Regarding the potentially proposed sequential regimen in Greece, an almost perfect correlation might occur concerning the registered drug packs in all used drugs even for clarithromycin 500 mg, marketed either with 14 or 21 tbs. The 14-day hybrid regimen matches quite properly for both PPI and amoxicillin, wasting only 2 tbs of the PPI and amoxicillin respectively, perfect for the clarithromycin (14 tbs) but quite poorly for the metronidazole wasting a considerable number of 16 tbs.…”

“…Extending the latter option to 14 days would show a perfect match wasting 2 tbs of PPI, 8 tbs of amoxicillin and 1 tb of levofloxacin. Concerning the third-line regimen, the 10-day rifabutin 150 mg-based regimen offers an acceptable choice, 3 and an almost proper correlation of registered drug packs exists regarding both the PPI (8 tbs waste) and rifabutin 500 mg (each bt contains 30 tbs; thus, there is a waste of 10 tbs) whereas poor for the amoxicillin 1 g (16 tbs waste).…”