Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Hokkaido, Japan.
Department of Clinical Laboratory Sciences, Shinshu University School of Medicine, Nagano, Hyogo, Japan.
Helicobacter. 2019 Aug;24(4):e12597. doi: 10.1111/hel.12597. Epub 2019 May 20.
Since "Helicobacter pylori (H. pylori) infection" was set as the indication in the Japanese Society for Helicobacter Research (JSHR) Guidelines 2009, eradication treatment for H. pylori gastritis is covered under insurance since 2013 in Japan, and the number of H. pylori eradication has rapidly increased. Under such circumstances, JSHR has made the third revision to the "Guidelines for diagnosis and treatment of H. pylori infection" for the first time in 7 years.
The Guideline Committee held 10 meetings. Articles published between the establishment of the 2009 Guidelines and March 2016 were reviewed and classified according to the evidence level; the statements were revised on the basis of this review. After inviting public comments, the revised statements were finalized using the Delphi method.
There was no change in the basic policy that H. pylori infectious disease is an indication for eradication. Other diseases presumed to be associated with H. pylori infection were added as indications. Serum pepsinogen level, endoscopic examination, and X-ray examination were added to the diagnostic methods. The effects of 1-week triple therapy consisting of potassium-competitive acid blocker (P-CAB), amoxicillin, and clarithromycin have improved, and high eradication rates can also be expected with proton pump inhibitors (PPI) or P-CAB combined with amoxicillin and metronidazole. If the susceptibility test is not performed, the triple PPI or P-CAB/amoxicillin/metronidazole therapy should be chosen, because the PPI/amoxicillin/metronidazole combination demonstrated a significantly higher eradication rate than PPI/amoxicillin/clarithromycin. In the proposal for gastric cancer prevention, we divided gastric cancer prevention measures by age from adolescent to elderly, who are at an increased gastric cancer risk, and presented measures for gastric cancer prevention primarily based on H. pylori eradication.
We expect the revised guidelines to facilitate appropriate interventions for patients with H. pylori infection and accomplish its eradication and prevention of gastric cancer.
自 2009 年日本幽门螺杆菌研究学会（JSHR）指南将“幽门螺杆菌（H. pylori）感染”定为适应证以来，日本自 2013 年起将 H. pylori 胃炎的根除治疗纳入医疗保险范围，H. pylori 的根除数量迅速增加。在此背景下，JSHR 时隔 7 年对《H. pylori 感染诊断和治疗指南》进行了第三次修订。
指南委员会召开了 10 次会议。根据证据水平对 2009 年指南制定以来至 2016 年 3 月期间发表的文章进行了回顾和分类，并在此基础上对陈述进行了修订。在邀请公众意见后，使用 Delphi 法对修订后的陈述进行了最终确定。
H. pylori 传染病为根除适应证的基本政策没有改变。将其他被认为与 H. pylori 感染相关的疾病也列为适应证。诊断方法中增加了血清胃蛋白酶原水平、内镜检查和 X 射线检查。由钾竞争性酸阻滞剂（P-CAB）、阿莫西林和克拉霉素组成的 1 周三联疗法的效果得到改善，质子泵抑制剂（PPI）或 P-CAB 联合阿莫西林和甲硝唑也可获得较高的根除率。如果不进行药敏试验，应选择三联 PPI 或 P-CAB/阿莫西林/甲硝唑治疗，因为 PPI/阿莫西林/甲硝唑联合治疗的根除率明显高于 PPI/阿莫西林/克拉霉素。在胃癌预防建议中，我们根据青少年和老年人群胃癌风险增加的情况，按年龄将胃癌预防措施分为青少年和老年人群，并主要基于 H. pylori 根除提出胃癌预防措施。
我们希望修订后的指南能够为 H. pylori 感染患者的适当干预提供便利，并实现其根除和预防胃癌。
