IV consenso mexicano sobre Helicobacter pylori

Abstract

Important advances have been made since the last Mexican consensus on the diagnosis and treatment of Helicobacter pylori (H. pylori) infection was published in 2007. Therefore, the Asociación Mexicana de Gastroenterología summoned 20 experts to produce "The Fourth Mexican Consensus on Helicobacter pylori". From February to June 2017, 4 working groups were organized, a literature review was performed, and 3 voting rounds were carried out, resulting in the formulation of 32 statements for discussion and consensus. From the ensuing recommendations, it was striking that Mexico is a country with an intermediate-to-low risk for gastric cancer, despite having a high prevalence of H. pylori infection. It was also corroborated that peptic ulcer disease, premalignant lesions, and histories of gastric cancer and mucosa-associated lymphoid tissue lymphoma should be considered clear indications for eradication. The relation of H. pylori to dyspeptic symptoms continues to be controversial. Eradication triple therapy with amoxicillin, clarithromycin, and a proton pump inhibitor should no longer be considered first-line treatment, with the following 2 options proposed to take its place: quadruple therapy with bismuth (proton pump inhibitor, bismuth subcitrate, tetracycline, and metronidazole) and quadruple therapy without bismuth (proton pump inhibitor, amoxicillin, clarithromycin, and metronidazole). The need for antimicrobial sensitivity testing when 2 eradication treatments have failed was also established. Finally, the promotion of educational campaigns on the diagnosis and treatment of H. pylori for both primary care physicians and the general population were proposed.

Phenotypic and Genotypic Antibiotic Resistance Patterns in Helicobacter pylori Strains From Ethnically Diverse Population in México

“…Resistance to clarithromycin was low in the first year of the survey, but after 20 years, it increased to levels that banned its clinical use; similar findings have been reported in Taiwan (65%) ( Wu et al, 2015 ), Chile (31.2%) ( Gonzalez-Hormazabal et al, 2018 ) and Brazil (19.5%) ( Ogata et al, 2013 ). Based on our studies, the most recent Mexican consensus no longer recommends the standard triple therapy for H. pylori eradication ( Bosques-Padilla et al, 2018 ).…”

“…Our hypothesis was further strengthened with the observation of absence of resistance to levofloxacin an antibiotic that hardly reach these communities. As mentioned above, the most recent Mexican consensus no longer recommend triple therapy ( Bosques-Padilla et al, 2018 ) based on susceptibility patterns in mestizo populations. Our results suggest triple therapy may still be an effective treatment in native communities and call the attention to differences between populations that must be taken into account when working in consensus for regions with both mestizo and native communities.…”

Helicobacter pylori prevalence in healthy Mexican children: comparison between two non-invasive methods

“…The frequency of H. pylori in Mexican children has decreased in recent years, while in 1998 the frequency of infection was found to be 50% ( Torres et al, 1998 ), in 2012 it was 38% ( Duque et al, 2012 ). However, the diagnosis of H. pylori infection in children is difficult to make, given that symptoms such as abdominal pain, nausea, vomiting, and occasionally diarrhea are unspecific ( Bosques-Padilla et al, 2018 ).…”

Antimicrobial resistance. Its importance and efforts to control it

“…In the last collection of strains in 2017, 60 % resistance to metrodinazole was recorded, and resistance to clarithromycin was relevant. 31 In 2018, the 4 th Mexican Consensus on Helicobacter pylori was established in collaboration with the Mexican Association Gastroenterology, where as a first line of treatment for regions with high rates of dual resistance (clarithromycin and metronidazole), the quadruple regimen is recommended for 14 days, with the possibility of considering two options: 31 -Quadruple therapy with bismuth salts: proton pump inhibitor, bismuth subcitrate, tetracycline and metronidazole. -Quadruple therapy without bismuth (concomitant therapy): bismuth subcitrate, amoxicillin, clarithromycin and metronidazole.…”