Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
Gut. 2020 Dec;69(12):2093-2112. doi: 10.1136/gutjnl-2020-322368. Epub 2020 Oct 1.
A global consensus meeting was held to review current evidence and knowledge gaps and propose collaborative studies on population-wide screening and eradication of for prevention of gastric cancer (GC).
28 experts from 11 countries reviewed the evidence and modified the statements using the Delphi method, with consensus level predefined as ≥80% of agreement on each statement. The Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach was followed.
Consensus was reached in 26 statements. At an individual level, eradication of reduces the risk of GC in asymptomatic subjects and is recommended unless there are competing considerations. In cohorts of vulnerable subjects (eg, first-degree relatives of patients with GC), a screen-and-treat strategy is also beneficial. eradication in patients with early GC after curative endoscopic resection reduces the risk of metachronous cancer and calls for a re-examination on the hypothesis of 'the point of no return'. At the general population level, the strategy of screen-and-treat for infection is most cost-effective in young adults in regions with a high incidence of GC and is recommended preferably before the development of atrophic gastritis and intestinal metaplasia. However, such a strategy may still be effective in people aged over 50, and may be integrated or included into national healthcare priorities, such as colorectal cancer screening programmes, to optimise the resources. Reliable locally effective regimens based on the principles of antibiotic stewardship are recommended. Subjects at higher risk of GC, such as those with advanced gastric atrophy or intestinal metaplasia, should receive surveillance endoscopy after eradication of .
Evidence supports the proposal that eradication therapy should be offered to all individuals infected with . Vulnerable subjects should be tested, and treated if the test is positive. Mass screening and eradication of should be considered in populations at higher risk of GC.
召开了一次全球共识会议，以审查现有证据和知识差距，并提出关于广泛人群筛查和根除 以预防胃癌（GC）的合作研究建议。
来自 11 个国家的 28 名专家审查了证据，并使用 Delphi 方法修改了陈述，共识水平预设为每个陈述的同意率≥80%。遵循推荐评估、制定和评估（GRADE）方法。
达成了 26 项共识。在个体层面，根除 可降低无症状受试者患 GC 的风险，除非存在竞争考虑因素，否则建议进行根除。在易患受试者队列中（例如，GC 患者的一级亲属），筛查和治疗策略也有益。在根治性内镜切除后的早期 GC 患者中根除 可降低异时性癌症的风险，并对“无法回头”的假设提出重新审视。在一般人群中，在 GC 发病率较高的地区，对 感染进行筛查和治疗的策略在年轻成年人中最具成本效益，建议在萎缩性胃炎和肠上皮化生发生之前进行。然而，这种策略在 50 岁以上的人群中可能仍然有效，并且可以整合或纳入国家医疗保健重点，如结直肠癌筛查计划，以优化资源。建议根据抗生素管理原则使用可靠的、在当地有效的治疗方案。有更高 GC 风险的受试者，如患有晚期胃萎缩或肠上皮化生的受试者，在根除 后应接受内镜监测。
证据支持以下建议，即应向所有感染 的个体提供根除治疗。应检测易感染人群，如果检测结果呈阳性，应进行治疗。应考虑在 GC 风险较高的人群中进行大规模筛查和根除 。
