Article

Second Asia-Pacific Consensus Guidelines for Helicobacter pylori infection

Division of Gastroenterology, Department of Medicine, Changi General Hospital, Singapore 529889.
Journal of Gastroenterology and Hepatology (Impact Factor: 3.63). 10/2009; 24(10):1587-600. DOI: 10.1111/j.1440-1746.2009.05982.x
Source: PubMed

ABSTRACT The Asia-Pacific Consensus Conference was convened to review and synthesize the most current information on Helicobacter pylori management so as to update the previously published regional guidelines. The group recognized that in addition to long-established indications, such as peptic ulcer disease, early mucosa-associated lymphoid tissue (MALT) type lymphoma and family history of gastric cancer, H. pylori eradication was also indicated for H. pylori infected patients with functional dyspepsia, in those receiving long-term maintenance proton pump inhibitor (PPI) for gastroesophageal reflux disease, and in cases of unexplained iron deficiency anemia or idiopathic thrombocytopenic purpura. In addition, a population 'test and treat' strategy for H. pylori infection in communities with high incidence of gastric cancer was considered to be an effective strategy for gastric cancer prevention. It was recommended that H. pylori infection should be tested for and eradicated prior to long-term aspirin or non-steroidal anti-inflammatory drug therapy in patients at high risk for ulcers and ulcer-related complications. In Asia, the currently recommended first-line therapy for H. pylori infection is PPI-based triple therapy with amoxicillin/metronidazole and clarithromycin for 7 days, while bismuth-based quadruple therapy is an effective alternative. There appears to be an increasing rate of resistance to clarithromycin and metronidazole in parts of Asia, leading to reduced efficacy of PPI-based triple therapy. There are insufficient data to recommend sequential therapy as an alternative first-line therapy in Asia. Salvage therapies that can be used include: (i) standard triple therapy that has not been previously used; (ii) bismuth-based quadruple therapy; (iii) levofloxacin-based triple therapy; and (iv) rifabutin-based triple therapy. Both CYP2C19 genetic polymorphisms and cigarette smoking can influence future H. pylori eradication rates.

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    • "Fluoroquinolones, especially levofloxacin, have been widely used to eradicate Helicobacter pylori worldwide [2]. The American College of Gastroenterology Guideline on the Management of Helicobacter pylori Infection [3], the second Asia Pacific consensus guidelines for Helicobacter pylori infection [4], and the Maastricht IV/Florence-Consensus Report [5] recommend that secondline H. pylori eradication rescue therapy consists of a PPI, a quinolone, and amoxicillin as an option. However, antibiotic resistance is one of the key factors responsible for failure of eradication of H. pylori, as well as poor compliance, high gastric acidity, a high bacterial load, and cytochrome P450 2C19 (CYP2C19) polymorphism [2] [6]. "
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    ABSTRACT: Fluoroquinolones, especially levofloxacin, are used in the eradication of Helicobacter pylori worldwide.Many consensus guidelines recommend that the second-line rescue therapy for H. pylori eradication consists of a proton pump inhibitor, a quinolone, and amoxicillin as an option. Unfortunately, quinolone is well associated with a risk of developing bacterial resistance. In this paper, we review quinolone-containing H. pylori eradication regimens and the challenges that influence the efficacy of eradication. It is generally suggested that the use of levofloxacin should be confined to “rescue” therapy only, in order to avoid a further rapid increase in the resistance of H. pylori to quinolone. The impact of quinolone-containing H. pylori eradication regimens on public health issues such as tuberculosis treatment must always be taken into account. Exposure to quinolone is relevant to delays in diagnosing tuberculosis and the development of drug resistance. Extending the duration of treatment to 14 days improves eradication rates by >90%. Tailored therapy to detect fluoroquinolone-resistant strains can be done by culture-based andmolecularmethods to provide better eradication rates. Molecular methods are achieved by using a real-time polymerase chain reaction to detect the presence of a gyrA mutation, which is predictive of treatment failure with quinolones-containing triple therapy.
    BioMed Research International 08/2014; 2014. DOI:10.1155/2014/151543 · 2.71 Impact Factor
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    • "Pakistan also has a high prevalence of H pylori infection and the strong virulence strains of H pylori i.e. cagA and vacA are predominant (Khan et al., 2013). Owing to the high prevalence of H pylori infection in Asia and its strong association with gastric carcinoma, Asia-Pacific consensus guidelines for management of H pylori infection have been developed (Fock et al., 2009). In addition, a Gastric cancer consensus conference recommended population based screening and treatment of H pylori in especially high risk population settings (Talley et al., 2008). "
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    ABSTRACT: Aim: To present an epidemiological and histological perspective of diseases of the gastrointestinal tract (including liver and biliary tract) at the Section of Histopathology, Department of Pathology, AKUH, Karachi, Pakistan. Materials and Methods: All consecutive endoscopic biopsies and resections between October 1 and December 31, 2012 were included. Results: A total of 2,323 cases were included. Carcinoma was overwhelmingly the commonest diagnosis on esophageal biopsies (69.1%); chronic helicobacter gastritis (45.6%) followed by adenocarcinoma (23.5%) were the commonest diagnoses on gastric biopsies; adenocarcinoma (27.3%) followed by ulcerative colitis (13.1%) were the commonest diagnoses on colonic biopsies; acute appendicitis (59.1%) was the commonest diagnosis on appendicectomy specimens; chronic viral hepatitis (44.8%) followed by hepatocellular carcinoma (23.4%) were the commonest diagnoses on liver biopsies; chronic cholecystitis was the commonest diagnosis (over 89%) on cholecystectomy specimens. Conclusions: Squamous cell carcinoma comprised 88.8% of esophageal cancers. About 67% were in the lower third and 56.5% were moderately differentiated; mean ages 49.8 years for females and 55.8 years for males; 66% cases were from South West Pakistan. Over 67% patients with gastric adenocarcinoma were males; mean ages 59 and 44 years in males and females respectively, about 74% gastric carcinomas were poorly differentiated; and 62.2% were located in the antropyloric region. About 63% patients with colorectal adenocarcinoma were males; mean ages 46.1 and 50.5 years for males and females respectively; tumor grade was moderately differentiated in 54%; over 80% were located in the left colon. In 21.2% appendicectomies, no acute inflammation was found. Acute appendicitis was most common in young people. Hepatitis C (66.3%) was more common than hepatitis B (33.7%); about 78% cases of hepatocellular carcinoma occurred in males; females comprised 76.7% patients with chronic cholecystitis; and 77.8% patients with gall bladder carcinoma. All resection specimens showed advanced cancers. Most cancers occurred after the age of 50 years.
    Asian Pacific journal of cancer prevention: APJCP 11/2013; 14(11):6997-7005. DOI:10.7314/APJCP.2013.14.11.6997 · 2.51 Impact Factor
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    • "A number of series have shown either low or no recurrence of ulcer at the end of one year compared with a natural recurrence rate of more than 70% [20] [21]. Several studies, the Maastricht III Consensus Report and the Second Asia-Pacific Consensus Guidelines for Helicobacter pylori infection, have demonstrated that ulcers recur in only a small percentage of patients following successful H. pylori eradication in comparison to a recurrence rate of 50% or greater within the course of one year when the organism persists and hence H. pylori eradication is recommended in patients with duodenal ulcer disease [22] [23] [24] [25] [26] [27] [28]. In a Cochrane Systematic Review, it was concluded that H. pylori eradication therapy is effective treatment for H. pylori positive peptic ulcer disease [29]. "
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    ABSTRACT: Helicobacter pylori (H. pylori) has a role in the multifactorial etiology of peptic ulcer disease. A link between H. pylori infection and duodenal ulcer disease is now established. Other contributing factors and their interaction with the organism may initiate the ulcerative process. The fact that eradication of H. pylori infection leads to a long-term cure in the majority of duodenal ulcer patients and the fact that the prevalence of infection is higher in ulcer patients than in the normal population are cogent arguments in favor of it being the primary cause of the ulceration. Against this concept there are issues that need explanation such as the reason why only a minority of infected persons develop duodenal ulceration when infection with H. pylori is widespread. There is evidence that H. pylori infection has been prevalent for several centuries, yet duodenal ulceration became common at the beginning of the twentieth century. The prevalence of duodenal ulceration is not higher in countries with a high prevalence of H. pylori infection. This paper debate puts forth the point of view of two groups of workers in this field whether H. pylori infection is the primary cause of duodenal ulcer disease or a secondary factor.
    Gastroenterology Research and Practice 03/2013; 2013:425840. DOI:10.1155/2013/425840 · 1.75 Impact Factor
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