Bourke Billy, Ceponis Peter, Chiba Naoki, Czinn Steve, Ferraro Richard, Fischbach Lori, Gold Ben, Hyunh Hien, Jacobson Kevan, Jones Nicola L, Koletzko Sibylle, Lebel Sylvie, Moayyedi Paul, Ridell Robert, Sherman Philip, van Zanten Sander, Beck Ivan, Best Linda, Boland Margaret, Bursey Ford, Chaun Hugh, Cooper Geraldine, Craig Brian, Creuzenet Carole, Critch Jeffrey, Govender Krishnasamy, Hassall Eric, Kaplan Alan, Keelan Monica, Noad Garth, Robertson Marli, Smith Lesley, Stein Markus, Taylor Diane, Walters Thomas, Persaud Robin, Whitaker Scott, Woodland Robert
Division of GI/Nutrition, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Ontario, Canada.
Can J Gastroenterol. 2005 Jul;19(7):399-408.
As an update to previously published recommendations for the management of Helicobacter pylori infection, an evidence-based appraisal of 14 topics was undertaken in a consensus conference sponsored by the Canadian Helicobacter Study Group. The goal was to update guidelines based on the best available evidence using an established and uniform methodology to address and formulate recommendations for each topic. The degree of consensus for each recommendation is also presented. The clinical issues addressed and recommendations made were: population-based screening for H. pylori in asymptomatic children to prevent gastric cancer is not warranted; testing for H. pylori in children should be considered if there is a family history of gastric cancer; the goal of diagnostic interventions should be to determine the cause of presenting gastrointestinal symptoms and not the presence of H. pylori infection; recurrent abdominal pain of childhood is not an indication to test for H. pylori infection; H. pylori testing is not required in patients with newly diagnosed gastroesophageal reflux disease; H. pylori testing may be considered before the use of long-term proton pump inhibitor therapy; testing for H. pylori infection should be considered in children with refractory iron deficiency anemia when no other cause has been found; when investigation of pediatric patients with persistent or severe upper abdominal symptoms is indicated, upper endoscopy with biopsy is the investigation of choice; the 13C-urea breath test is currently the best noninvasive diagnostic test for H. pylori infection in children; there is currently insufficient evidence to recommend stool antigen tests as acceptable diagnostic tools for H. pylori infection; serological antibody tests are not recommended as diagnostic tools for H. pylori infection in children; first-line therapy for H. pylori infection in children is a twice-daily, triple-drug regimen comprised of a proton pump inhibitor plus two antibiotics (clarithromycin plus amoxicillin or metronidazole); the optimal treatment period for H. pylori infection in children is 14 days; and H. pylori culture and antibiotic sensitivity testing should be made available to monitor population antibiotic resistance and manage treatment failures.
作为对先前发表的幽门螺杆菌感染管理建议的更新，加拿大幽门螺杆菌研究小组在一次共识会议上对14个主题进行了循证评估。目标是使用既定且统一的方法，根据现有最佳证据更新指南，以处理并制定每个主题的建议。同时还列出了每项建议的共识程度。所涉及的临床问题及提出的建议如下：不建议对无症状儿童进行基于人群的幽门螺杆菌筛查以预防胃癌；如果有胃癌家族史，则应考虑对儿童进行幽门螺杆菌检测；诊断性干预的目标应是确定出现的胃肠道症状的病因，而非幽门螺杆菌感染的存在；儿童反复腹痛并非检测幽门螺杆菌感染的指征；新诊断的胃食管反流病患者无需进行幽门螺杆菌检测；在使用长期质子泵抑制剂治疗前可考虑进行幽门螺杆菌检测；当未发现其他病因时，对于难治性缺铁性贫血患儿应考虑检测幽门螺杆菌感染；当需要对持续或严重上腹部症状的儿科患者进行检查时，首选的检查是上消化道内镜检查并活检；13C尿素呼气试验是目前儿童幽门螺杆菌感染的最佳非侵入性诊断测试；目前尚无足够证据推荐粪便抗原检测作为幽门螺杆菌感染的可接受诊断工具；不建议将血清学抗体检测作为儿童幽门螺杆菌感染的诊断工具；儿童幽门螺杆菌感染的一线治疗是每日两次的三联药物疗法，由质子泵抑制剂加两种抗生素（克拉霉素加阿莫西林或甲硝唑）组成；儿童幽门螺杆菌感染的最佳治疗期为14天；应提供幽门螺杆菌培养和抗生素敏感性检测，以监测人群抗生素耐药性并处理治疗失败情况。
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