世界胃肠病学组织全球指南:幽门螺杆菌

World Gastroenterology Organisation Global Guidelines:Helicobacter pylori

幽门螺杆菌(Hp)仍然是全球范围内的主要健康问题之一,其相关消化性溃疡病和胃癌引起相当高的发病率和死亡率,疾病负荷大部分落在非富裕人群中。与大多数传染病一样,社会经济状况的改善可阻断传播,对降低疾病负荷有着最显著的影响,这一点已可在全球多个地区观察到,但在许多生活水平改善缓慢的地区,感染率仍然很高。同时,最佳临床处理和治疗路径仍未确定,诊治路径随着抗菌药物耐药模式的变化而不断演变。尽管已经过数十年的研究和临床实践,主要挑战依然存在。寻求最有效、安全、简单的疗法仍然是临床医师面对的主要问题。有效的疫苗似仍遥不可及。临床指南经常会提供不一致的建议,因其很难在具有不同疾病谱、不同抗菌药物耐药率和巨大资源差异的各类人群中实现关联。地区因素是决定Hp感染的影响和处理策略的核心,因此,处理路径应基于现有的最适当地信息,而非仅仅源自对其他地区制定的指南的推断,因为这些指南的适用性不高。为此,本次世界胃肠病学组织Hp指南的修订采用“阶梯”方法,旨在总结处理原则,根据既定的关键治疗原则,利用当地信息和可获得的资源指导地区实践,为务实、适当、可行的诊断和治疗路径提供建议。

Helicobacter pylori(Hp)continues to be a major health problem worldwide,causing considerable morbidity and mortality due to peptic ulcer disease and gastric cancer.The burden of disease falls disproportionately on less well-resourced populations.As with most infectious diseases,the greatest impact on reducing this burden comes from improvements in socioeconomic status,which interrupt transmission.This has been observed in many regions of the world,but the prevalence of infection remains high in many regions in which improvements in living standards are slow to occur.Meanwhile,the optimal clinical management and treatment pathways remain unsettled and are evolving with changing antimicrobial resistance patterns.Despite decades of research and clinical practice,major challenges remain.The quest for the most effective,safe,and simple therapy is still a major issue for clinicians.An effective vaccine also still appears to be elusive.Clinical guidelines not infrequently proffer discordant advice.It is very difficult for guidelines to achieve relevance across a variety of populations with varying spectrums of disease,antimicrobial resistance rates,and vastly different resources.As local factors are central to determining the impact and management strategies for Hp infection,it is important for pathways to be based on the best available local knowledge,rather than solely extrapolated from guidelines formulated in other regions,which may be less applicable.To this end,this revision of the World Gastroenterology Organisation Hp guideline uses a“cascades”approach that seeks to summarize the principles of management and offer advice for pragmatic,relevant,and achievable diagnostic and treatment pathways based on established key treatment principles and using local knowledge and available resources to guide regional practice.