2017年台湾幽门螺杆菌共识:关于幽门螺杆菌感染的临床管理、筛选治疗和监控以改善台湾地区胃癌控制的共识

2017 Taiwan Helicobacter pylori consensus:the clinical management,screening-to-treat,and surveillance of Helicobacter pylori infection to improve gastric cancer control in Taiwan

既往的国际共识为幽门螺杆菌(Helicobacter pylori,H.pylori)感染的管理提供了一般性政策。但是,H.pylori的流行率和抗菌素耐药性、药物和内镜检查的可用性存在地理差异。因此,需要全国或区域性共识来改善H.pylori感染和胃癌的控制。台湾地区H.pylori管理共识包括三个部分:最佳的诊断方法和治疗适应证;当前治疗策略;胃癌的筛查—治疗和监控。本文强调了关于草案声明发展和证据水平决定的最近数据。共有24个共识意见。第一节有7个推荐声明关于H.pylori感染的诊断和治疗的适应证。第二节有10个推荐声明为一线、二线和三线治疗提供更新的治疗方案。第三节有7个推荐声明关于根除H.pylori降低胃癌风险的成本效益分析。根除H.pylori后,共识突出内镜监控和/或化学预防来进一步减轻胃癌的负担。这一共识声明更新了改善H.pylori感染和胃癌患病率高的台湾地区的H.pylori感染临床管理的建议。

Previous international consensus statements provided general policies for the management of Helicobacter pylori（ H. 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： optimal diagnosis and indications; current treatment strategies; screening-to-treat and surveillance for control of gastric cancer. The literature reviewed emphasized recent data for development of draft statements and determination of levels of evidence. 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 ten 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.