Caselli M, Zullo A, Maconi G, Parente F, Alvisi V, Casetti T, Sorrentino D, Gasbarrini G
School of Gastroenterology, University of Ferrara, Italy.
Dig Liver Dis. 2007 Aug;39(8):782-9. doi: 10.1016/j.dld.2007.05.016. Epub 2007 Jul 2.
Proper management of Helicobacter pylori infection in clinical practice--when supported by evidence-based data--is expected to produce substantial cost-efficacy advantages. This consideration has prompted the Cervia Working Group to organise a meeting of experts to update the National Guidelines on the diagnosis and treatment of H. pylori infection in Italy. Recommendations in the new European Guidelines were considered in the National setting, here in the light of factors such as the incidence of gastric cancer and gastric lymphoma, the accessibility to different diagnostic tools, the prevalence of bacterial resistance against antibiotics, and the availability of different drugs. The main revisions in respect to the previous guidelines include H. pylori eradication in non-ulcer dyspepsia patients and in non-steroidal, anti-inflammatory drug users, as well as in patients with idiopathic thrombocytopenic purpura and iron deficiency anaemia. The stool antigen test is now accepted as a valid test for confirmation of H. pylori eradication following therapy. New therapeutic approaches have been recommended for both first- (sequential therapy) and second-line (levofloxacin-based) treatment in our country.
在临床实践中,幽门螺杆菌感染的恰当管理——在循证数据的支持下——有望产生显著的成本效益优势。这一考量促使塞尔维耶工作组组织了一次专家会议,以更新意大利关于幽门螺杆菌感染诊断和治疗的国家指南。新欧洲指南中的建议在国家层面得到了考量,在此依据了诸如胃癌和胃淋巴瘤的发病率、不同诊断工具的可及性、细菌对抗生素的耐药率以及不同药物的可获得性等因素。相较于先前的指南,主要修订内容包括对非溃疡性消化不良患者、非甾体抗炎药使用者、特发性血小板减少性紫癜患者以及缺铁性贫血患者进行幽门螺杆菌根除治疗。粪便抗原检测现被认可为治疗后确认幽门螺杆菌根除的有效检测方法。我国针对一线治疗(序贯疗法)和二线治疗(基于左氧氟沙星)均推荐了新的治疗方法。