Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany.
Curr Opin Gastroenterol. 2013 Nov;29(6):669-75. doi: 10.1097/MOG.0b013e328365d443.
This review focuses on new aspects of recently published guidelines for the management of Helicobacter pylori infection as well as progress in diagnostic tests and treatment regimens. We also discuss new strategies for gastric cancer prevention.
The general recommendation to treat H. pylori infection whenever diagnosed still faces resistance for reasons that are pertinent to the diversity of related clinical outcomes and to the complexity of eradication regimens. Thus, new updated guidelines for the management of H. pylori infection have been released in several continents. Progress has been made in molecular diagnostic tests for the detection of antibiotic resistance and serological tests for the detection of advanced gastric atrophic changes. Effective quadruple therapies in various combinations of 'traditional drugs' have been introduced with sequential or concomitant order of administration. Moreover, traditional drugs in a new galenic formulation have been introduced to overcome increasing H. pylori antibiotic resistance. Effective strategies for gastric cancer prevention have been adopted in some countries with high gastric cancer incidence, and have successfully contributed to lower the gastric cancer incidence. A screen-and-treat strategy for individuals at increased risk for gastric cancer needs to be further explored also in areas with low/moderate incidence of gastric cancer.
New guidelines share many universal similarities across countries but respect and emphasize specific needs and requirements in individual communities. Various combinations of traditional drugs have been successfully introduced to overcome the increasing H. pylori antibiotic resistance. Gastric cancer prevention by a screen and treat strategy showed promising results.
本综述重点关注最近发布的关于幽门螺杆菌感染管理指南的新方面，以及诊断检测和治疗方案的进展。我们还讨论了胃癌预防的新策略。
由于与相关临床结果的多样性和根除方案的复杂性相关的原因，每当诊断出幽门螺杆菌感染时，一般建议进行治疗，仍然面临阻力。因此，在几个大洲发布了新的更新的幽门螺杆菌感染管理指南。在检测抗生素耐药性的分子诊断检测和检测晚期胃萎缩变化的血清学检测方面取得了进展。已经引入了各种“传统药物”组合的有效四联疗法，具有序贯或同时给药的顺序。此外，还引入了新的制剂形式的传统药物，以克服日益增加的幽门螺杆菌抗生素耐药性。在胃癌发病率较高的一些国家采用了有效的胃癌预防策略，并成功降低了胃癌的发病率。在胃癌发病率低/中等的地区，也需要进一步探索针对胃癌高危人群的筛查和治疗策略。
新指南在国家之间具有许多普遍相似之处，但尊重并强调了各个社区的具体需求和要求。已经成功引入了各种传统药物组合，以克服日益增加的幽门螺杆菌抗生素耐药性。通过筛查和治疗策略进行胃癌预防显示出有希望的结果。
