Vietnam Association of Gastroenterology (VNAGE) consensus on the management of Helicobacter pylori infection

Abstract

Helicobacter pylori (H. pylori) infection is prevalent and has a rapidly increasing antibiotic resistance rate in Vietnam. Reinfection is quite common, and gastric carcinoma remains one of the most common malignancies, which is not uncommon to develop after successful eradication. The purpose of this consensus is to provide updated recommendations on the management of H. pylori infection in the country. The consensus panel consisted of 32 experts from 14 major universities and institutions in Vietnam who were invited to review the evidence and develop the statements using the Delphi method. The process followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The consensus level was defined as ≥80% for agreement on the proposed statements. Due to the limited availability of high-quality local evidence, this consensus was also based on high-quality evidence from international studies, especially those conducted in other populations in the Asia–Pacific region. The panel finally reached a consensus on 27 statements after two voting rounds, which consisted of four sections (1) indications for testing and selection of diagnostic tests (2), treatment regimens, (3) post-treatment confirmation of H. pylori status, and (4) reinfection prevention methods and follow-up after eradication. Important issues that require further evidence include studies on third-line regimens, strategies to prevent H. pylori reinfection, and post-eradication follow-up for precancerous gastric lesions. We hope this consensus will help guide the current clinical practice in Vietnam and promote multicenter studies in the country and international collaborations.

Antibiotic resistance and heteroresistance in Helicobacter pylori isolates from symptomatic Vietnamese children: A prospective multicenter study

“…30,58 Furthermore, the integration of LEV as an empiric alternative first-line treatment for H. pylori in Vietnamese adults has also contributed to the emergence and rapid increase of LEV resistance. 48 Importantly, self-medication is also very common in Vietnam. 31 These factors might contribute to the high level of LEV resistance in children.…”

“…The TET-resistant strains in children are probably transmitted from adults, where resistance rates ranged from 5.8% 33 to 10.9%, 66 since TET is commonly used as a first-line regimen in adults. 48 In Vietnam, most studies have reported higher secondary resistance compared with primary resistance. 28,29,44 Our results showed similar trends for CLA, LEV, and TET, but without statistically significant differences.…”

“…Consequently, CLA may rarely be effective in eradication regimens in our region, with implications for clinical practice. Based on the latest consensus on H. pylori management in Vietnamese adults (2023) 48 and in children (2017), 49 CLA‐based regimens are no longer recommended in empiric treatment unless the AST shows a susceptible result.…”

“…Alternatively, MET resistance can be overcome in vivo by using higher dosages (30 mg/kg/day) 55 . Nevertheless, MET‐based regimens are currently recommended as first‐line therapy in Vietnam due to the CLA resistance rates exceeding 20% 4,11,48 . This may contribute to the further development of MET resistance.…”

“…In some regions with high rates of macrolides resistance, LEV is commonly prescribed to treat other common infectious conditions such as acute bacterial sinusitis, bacterial bronchitis, and atypical pneumonia in both adults and children 30,58 . Furthermore, the integration of LEV as an empiric alternative first‐line treatment for H. pylori in Vietnamese adults has also contributed to the emergence and rapid increase of LEV resistance 48 . Importantly, self‐medication is also very common in Vietnam 31 .…”