Miwa H, Sato N
Department of Gastroenterology, Juntendo University, School of Medicine.
Nihon Rinsho. 2001 Feb;59(2):301-7.
With increased evidence of H. pylori infection being deeply related with various gastric diseases, its curative therapy will be approved by social security foundation soon also in Japan. Japanese Society of Helicobacter reported a guideline for H. pylori diagnosis and treatment in July 2000. In the guideline, only peptic ulcers and low grade MALT lymphomas are recommended as an indication of H. pylori eradication and other diseases such as atrophic gastritis, post EMR state for early gastric cancer and post-operated stomach due to gastric cancer, hyperplastic polyps and non-ulcer dyspepsia, were not included. It is speculated that while benefit of eradication therapy for peptic ulcers and low grade MALT lymphomas has been supported by much clinical evidence, that for other diseases was judged not to be enough. Especially as to atrophic gastritis, eradication therapy might be considered in aspect of decreasing gastric cancer risk in Japan. Since accumulated epidemiological and experimental data strongly support its positive correlation with cancer risk, patients in high risk group for gastric cancer could be included for a target eradication therapy. In present, indication of the therapy should be clinically and socially decided according to individual patient.
随着越来越多的证据表明幽门螺杆菌感染与各种胃部疾病密切相关，其治疗方法在日本也将很快被纳入医保。日本幽门螺杆菌协会于2000年7月发布了一份幽门螺杆菌诊断和治疗指南。在该指南中，仅推荐将消化性溃疡和低度黏膜相关淋巴组织淋巴瘤作为根除幽门螺杆菌的指征，而其他疾病如萎缩性胃炎、早期胃癌内镜下黏膜切除术（EMR）后状态、胃癌手术后的胃、增生性息肉和非溃疡性消化不良等均未被纳入。据推测，虽然消化性溃疡和低度黏膜相关淋巴组织淋巴瘤根除治疗的益处已得到大量临床证据的支持，但其他疾病的证据则被认为不足。特别是对于萎缩性胃炎，在日本，从降低胃癌风险的角度考虑，可能会考虑进行根除治疗。由于积累的流行病学和实验数据有力地支持了其与癌症风险的正相关关系，胃癌高危组患者可被纳入根除治疗的目标人群。目前，该治疗的指征应根据个体患者的情况进行临床和社会层面的决定。
