Population-Based Strategies for Helicobacter pylori-Associated Disease Management: Asian Perspective

Abstract

Asia has the largest population of any continent and the highest incidence of gastric cancer in the world, making it very important in the context of Helicobacter pylori infection. Several new guidelines in East Asian countries include expanded indications for H. pylori eradication. Importantly, the Japanese national health insurance system now covers expenses for all H. pylori-infected subjects up to second-line treatment. According to current guidelines, standard triple therapy containing a proton pump inhibitor (PPI) and two antibiotics, clarithromycin and amoxicillin/metronidazole, is still the preferred first-line regimen for treatment of H. pylori infection. However, in following years, the efficacy of legacy triple regimens has been seriously challenged, and they are becoming ineffective. Moreover, some regions in Asia show patterns of emerging antimicrobial resistance. Therefore, clarithromycin-containing triple therapy should be abandoned, as it is no longer effective unless local clarithromycin resistance is low or culture confirms susceptibility to clarithromycin. More effective clarithromycin-based regimens are now replacing standard triple therapies as empirical first-line treatments on the basis of the understanding of the local prevalence of H. pylori antimicrobial resistance. These include the bismuth and non-bismuth quadruple, sequential, and dual-concomitant (hybrid) regimens. Author a) Miftahussurur M., b) Yamaoka Y.

Comparing the Efficacy of Sequential and Standard Quadruple Therapy for Eradication of H. Pylori Infection

“…The prevalence of H. pylori infection in developing countries is greater compared to developed countries (3). Furthermore, this prevalence varies in different countries and geographic regions of Asia (5). In this regard, prevalence rate in Japan, China, and Singapore is 39%, 58%, and 31%, respectively.…”

The comparison of levofloxacin- and clarithromycin-based bismuth quadruple therapy regimens in Helicobacter pylori eradication

“…[ 1 ] In general, the prevalence of this infection in developing countries is higher than in developed countries. [ 2 ] Moreover, the prevalence of H. pylori infection is different in various countries and geographic areas in Asia,[ 2 3 ] so that the prevalence rate is 31% in Singapore, 39% in Japan, 58% in China, 75% in Vietnam, and 58.% in China. [ 4 ] The rate of H. pylori infection in a diverse area of Iran is different, so that the prevalence in Kurdistan is 36% and in Ardabil 90%.…”

“…[ 9 10 ] Eradicating H. pylori prevents the recurrence of disease, decreases the risk of gastric cancer, prevents the spread of H. pylori infection, and decreases the cost of gastric cancer treatment. [ 3 ]…”

“…[ 11 ] Clarithromycin resistance in Iran has increased from 1.4% in 1997 to 26.5% in 2013. [ 3 ] The current treatment relies on a combination of antimicrobial agents including levofloxacin, clarithromycin, metronidazole, and amoxicillin and acid suppressant agents such as proton-pump inhibitors. Recently, clarithromycin-based regimens are considered as standard triple therapies.…”