Sheu Bor-Shyang, Wu Ming-Shiang, Chiu Cheng-Tang, Lo Jing-Chuan, Wu Deng-Chyang, Liou Jyh-Ming, Wu Chun-Ying, Cheng Hsiu-Chi, Lee Yi-Chia, Hsu Ping-I, Chang Chun-Chao, Chang Wei-Lun, Lin Jaw-Town
Departments of Institute of Clinical Medicine and Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan.
Helicobacter. 2017 Jun;22(3). doi: 10.1111/hel.12368. Epub 2017 Jan 8.
Previous international consensus statements provided general policies for the management of Helicobacter pylori infection. However, there are geographic differences in the prevalence and antimicrobial resistance of H. pylori, and in the availability of medications and endoscopy. Thus, nationwide or regional consensus statements are needed to improve control of H. pylori infection and gastric cancer.
This consensus statement for management of H. pylori in Taiwan has three major sections: (1) optimal diagnosis and indications; (2) current treatment strategies; and (3) screening-to-treat and surveillance for control of gastric cancer. The literature review emphasized recent data for development of draft statements and determination of levels of evidence. Twenty-five Taiwan experts conducted a consensus conference, by a modified Delphi process, to modify the draft statements. Consensus, defined as an agreement of least 80% of the experts, and recommendation grade were determined by anonymous voting.
There were 24 consensus statements. Section 1 has seven statements on recommendations for the diagnosis and indications for treatment of H. pylori infection. Section 2 has 10 statements that provide an updated treatment algorithm for first-line, second-line, and third-line regimens. Section 3 has seven statements regarding H. pylori eradication for reducing the risk of gastric cancer, with a cost-benefit analysis. After H. pylori eradication, the consensus highlights the use of endoscopic surveillance and/or chemoprevention to further reduce the burden of gastric cancer.
This consensus statement has updated recommendations for improving the clinical management of H. pylori infection in areas such as Taiwan, which have high prevalence of H. pylori infection and gastric cancer.
以往的国际共识声明提供了幽门螺杆菌感染管理的一般政策。然而，幽门螺杆菌的患病率、抗菌药物耐药性以及药物和内镜检查的可及性存在地域差异。因此，需要全国性或地区性的共识声明来改善幽门螺杆菌感染和胃癌的控制。
这份台湾地区幽门螺杆菌管理的共识声明主要分为三个部分：（1）最佳诊断与适应证；（2）当前治疗策略；（3）胃癌防控的筛查-治疗与监测。文献综述重点关注了近期数据，以制定声明草案并确定证据水平。25位台湾专家通过改良的德尔菲法召开了一次共识会议，对声明草案进行修改。通过匿名投票确定至少80%专家达成一致的共识以及推荐等级。
共有24项共识声明。第1部分有7项关于幽门螺杆菌感染诊断和治疗适应证的推荐声明。第2部分有10项声明，提供了一线、二线和三线治疗方案的最新治疗算法。第3部分有7项关于根除幽门螺杆菌以降低胃癌风险的声明，并进行了成本效益分析。在根除幽门螺杆菌后，共识强调使用内镜监测和/或化学预防措施，以进一步减轻胃癌负担。
这份共识声明更新了相关推荐，以改善台湾地区等幽门螺杆菌感染和胃癌高发地区幽门螺杆菌感染的临床管理。
