Korean J Gastroenterol.  2014 Mar;63(3):151-157. 10.4166/kjg.2014.63.3.151.

New Guidelines for Helicobacter pylori Treatment: Comparisons between Korea and Japan

Affiliations
  • 1Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea. sunyoung@kuh.ac.kr

Abstract

Korea and Japan show the highest incidence of gastric cancer and Helicobacter pylori infection. New 2013 guidelines on H. pylori infection differ between the two countries with regard to the indications for H. pylori eradication, diagnostic methods, and treatment regimens. Indications for eradication in Korean guideline focus on specific diseases such as peptic ulcer disease, low-grade gastric mucosa-associated lymphoid tissue lymphoma, and after resection of early gastric cancer, while Japanese guideline includes all H. pylori-associated gastritis for the prevention of dissemination. With regard to the diagnosis, either noninvasive or invasive method (except for bacterial culture) is recommended in Korea, while two noninvasive tests including serum anti-H. pylori IgG antibody level are preferred in Japan. As for the treatment regimens, second-line treatment (quadruple bismuth-containing regimen) is recommended without first-line triple therapy in areas of high clarithromycin resistance in Korea. However, there is no bismuth-based second-line treatment in Japan, and the Japanese regimen consists of a lower dose of antibiotics for a shorter duration (7 days). Such discrepancies between the two countries are based not only on the differences in the literature search and interpretation, but also on the different approvals granted by the national health insurance system, manufacturing process of the antibiotics, and diagnostic techniques in each country. Collaborations are required to minimize the discrepancies between the two countries based on cost-effectiveness.

Keyword

Diagnosis; Eradication; Guidelines; Helicobacter pylori; Treatment

MeSH Terms

Anti-Bacterial Agents/pharmacology/*therapeutic use
Antibodies/blood
Bismuth/pharmacology/therapeutic use
Disease Eradication/trends
Drug Administration Schedule
Guidelines as Topic
Helicobacter Infections/complications/diagnosis/*drug therapy
*Helicobacter pylori/drug effects/immunology
Humans
Japan
Lymphoma, B-Cell, Marginal Zone/complications/surgery
Republic of Korea
Stomach Neoplasms/complications/surgery
Anti-Bacterial Agents
Antibodies
Bismuth

Figure

  • Fig. 1. Diagnostic and therapeutic methods for Helicobacter pylori infection in 2013 guidelines. Bacterial culture is not recommended as a diagnostic method in Korea, while either two noninvasive tests or one invasive test is recommended in Japan. Notably, a decrease relative to the initial serum antibody level of more than 50% after 6–12 months is considered the most reliable method in Japan for determining successful eradication. With regard to the treatment, first-line treatment can be skip-ped and move directly to second-line treatment using bismuth-based quadruple therapy in cases with a high clarithromycin resistance rate in Korea, whereas neither 14 days nor bismuth-based regimen is recommended in Japan. The Japanese guideline recommends lower dose of antibiotics for shorter duration (7 days) for eradication. PPI, proton pump inhibitor.


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