Chey William D, Howden Colin W, Moss Steven F, Morgan Douglas R, Greer Katarina B, Grover Shilpa, Shah Shailja C
Division of Gastroenterology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA.
University of Tennessee College of Medicine, Memphis, Tennessee, USA.
Am J Gastroenterol. 2024 Sep 1;119(9):1730-1753. doi: 10.14309/ajg.0000000000002968. Epub 2024 Sep 4.
Helicobacter pylori is a prevalent, global infectious disease that causes dyspepsia, peptic ulcer disease, and gastric cancer. The American College of Gastroenterology commissioned this clinical practice guideline (CPG) to inform the evidence-based management of patients with H. pylori infection in North America. This CPG used Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology to systematically analyze 11 Population, Intervention, Comparison, and Outcome questions and generate recommendations. Where evidence was insufficient or the topic did not lend itself to GRADE, expert consensus was used to create 6 key concepts. For treatment-naive patients with H. pylori infection, bismuth quadruple therapy (BQT) for 14 days is the preferred regimen when antibiotic susceptibility is unknown. Rifabutin triple therapy or potassium-competitive acid blocker dual therapy for 14 days is a suitable empiric alternative in patients without penicillin allergy. In treatment-experienced patients with persistent H. pylori infection, "optimized" BQT for 14 days is preferred for those who have not been treated with optimized BQT previously and for whom antibiotic susceptibility is unknown. In patients previously treated with optimized BQT, rifabutin triple therapy for 14 days is a suitable empiric alternative. Salvage regimens containing clarithromycin or levofloxacin should only be used if antibiotic susceptibility is confirmed. The CPG also addresses who to test, the need for universal post-treatment test-of-cure, and the current evidence regarding antibiotic susceptibility testing and its role in guiding the choice of initial and salvage treatment. The CPG concludes with a discussion of proposed research priorities to address knowledge gaps and inform future management recommendations in patients with H. pylori infection from North America.
幽门螺杆菌是一种广泛流行的全球性传染病，可导致消化不良、消化性溃疡病和胃癌。美国胃肠病学会委托制定本临床实践指南（CPG），为北美幽门螺杆菌感染患者的循证管理提供依据。本CPG采用推荐分级、评估、制定和评价（GRADE）方法，系统分析了11个关于人群、干预措施、对照和结局的问题，并提出了建议。在证据不足或该主题不适合采用GRADE方法时，通过专家共识形成了6个关键概念。对于初治幽门螺杆菌感染患者，当抗生素敏感性未知时，14天的铋剂四联疗法（BQT）是首选方案。对于无青霉素过敏的患者，14天的利福布汀三联疗法或钾离子竞争性酸阻滞剂双联疗法是合适的经验性替代方案。对于有幽门螺杆菌持续感染的复治患者，对于既往未接受过优化BQT治疗且抗生素敏感性未知的患者，首选14天的“优化”BQT。对于既往接受过优化BQT治疗的患者，14天的利福布汀三联疗法是合适的经验性替代方案。仅在确认抗生素敏感性时，才应使用含克拉霉素或左氧氟沙星的挽救方案。本CPG还讨论了检测对象、普遍进行治疗后治愈检测的必要性，以及目前关于抗生素敏感性检测及其在指导初始和挽救治疗选择中的作用的证据。CPG最后讨论了拟议的研究重点，以填补知识空白，并为北美幽门螺杆菌感染患者未来的管理建议提供依据。
