Kim Nayoung, Kim Jae J, Choe Yon Ho, Kim Hyun Soo, Kim Jin Il, Chung In-Sik
Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Seoul, Korea.
Korean J Gastroenterol. 2009 Nov;54(5):269-78. doi: 10.4166/kjg.2009.54.5.269.
Eleven years has passed since the guideline of the Korean College of Helicobacter and Upper Gastrointestinal Research group for H. pylori infection was produced in 1998. During this period the research for H. pylori has much progressed that H. pylori is now regarded as the major cause of gastric cancer. The seroprevalence of H. pylori in Korea was found to be decreased especially below the age of 40s and in the area of Seoul-Gyeonggi province, and annual reinfection rate of H. pylori has decreased up to 2.94%. In the aspect of diagnostic tests of H. pylori the biopsy is recommended in the body instead of antrum in the subjects with atrophic gastritis and/or intestinal metaplasia for the modified Giemsa staining or Warthin Starry silver staining. The urea breath test is the test of choice to confirm eradication when follow-up endoscopy is not necessary. Definite indication for H. pylori eradication is early gastric cancer in addition to the previous indications of peptic ulcer including scar and Marginal zone B cell lymphoma (MALT type). Treatment is also recommended for the relatives of gastric cancer patient, unexplained iron deficiency anemia, and chronic idiopathic thrombocytopenic purpura. One or two week treatment of proton pump inhibitor (PPI) based triple therapy consisting of one PPI and two antibiotics, clarithromycin and amoxicillin, is recommended as the first line treatment regimen. In the case of treatment failure, one or two weeks of quadruple therapy (PPI+metronidazole+tetracycline+bismuth) is recommended. Herein, Korean College of Helicobacter and Upper Gastrointestinal Research proposes a diagnostic and treatment guideline based on currently available evidence.
自1998年韩国幽门螺杆菌与上消化道研究组发布幽门螺杆菌感染指南以来，已经过去了11年。在此期间，对幽门螺杆菌的研究取得了很大进展，幽门螺杆菌现在被认为是胃癌的主要病因。韩国幽门螺杆菌的血清流行率被发现有所下降，尤其是在40岁以下人群以及首尔-京畿道地区，幽门螺杆菌的年再感染率已降至2.94%。在幽门螺杆菌的诊断测试方面，对于患有萎缩性胃炎和/或肠化生的受试者，建议在胃体部而非胃窦部进行活检，以进行改良吉姆萨染色或沃辛-斯塔瑞银染色。当无需进行后续内镜检查时，尿素呼气试验是确认根除的首选检测方法。除了消化性溃疡（包括瘢痕和边缘区B细胞淋巴瘤（MALT型））的既往指征外，幽门螺杆菌根除的确切指征是早期胃癌。对于胃癌患者的亲属、不明原因的缺铁性贫血以及慢性特发性血小板减少性紫癜患者，也建议进行治疗。推荐以质子泵抑制剂（PPI）为基础的三联疗法（一种PPI加两种抗生素，即克拉霉素和阿莫西林）进行1至2周的治疗作为一线治疗方案。在治疗失败的情况下，建议进行1至2周的四联疗法（PPI + 甲硝唑 + 四环素 + 铋剂）。在此，韩国幽门螺杆菌与上消化道研究组基于现有证据提出了一项诊断和治疗指南。
