Diagnosis and Treatment of Helicobacter pylori Infection in Korea

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Abstract

Since the guidelines of the US National lnstitute of Health for Helicobacter pylori (H. pylori jinfection were produced in 1994, several recommendations for the management of the infection have been developed independently in European and Asian Pacific countrise. However, those are not identicatly use prevalence rate of H. pylori infeciton, incidence of gastric cancer, and regional economic status vary significantly in different localities. Until recently, there have been considerable confusions over the management of H. pylori infection. Therefore, it is urgent to develop our own consensus guidelines at the moment. In Febroary 1998, the Korean H. pylori Study Group organized a domestic consensus meeting and has made recommendations based on available evidences reported, after taking the mentioned regional characteristics into consideration. A number of diagnostic tests for the infection are available throughout the country. When endoscopy is clinically available, biopsy urease testing and histology are recommended as the tests of choice, Serological test is not mcommended at the moment because of its low sensitivity and especially low specificity reported in Korea. The urea breath test is more sensitive and specific noninvasive test than serological test, but it is not widely available yet All gastric and duodenal ulcer patients who are infected with H. pylori should be treated for H. pylori regardless of the stage of ulcer (active, complicated or scarring). Treatment is also recommended for the patients with endoscopic resection of early gastric cancer (EGC) and for the patients with 1ow- gastric mucosa-associated lymphoid tissue (MALT) lymphoma, although supporting evidence is limited. However, patients with family history of gastric cancer and patients with non-ulcer dyspepsia, gastritis or duodenitis are not the subjects for eradication. Asymptomatic persons and patients who want to be treated should not be tested and treated, either. It was concluded that there wasn't sufficient evidence that cure of H. pylori infection reduces the risk of gastric adenocarcinoma or prevents the development of it. Therefore, eradication of H. pylori should not be attempted for the purpose of preventing development of gastric cancer. Post-treatment testing was not always recommended for all patients. It is appropriate to confirm eradicatian and ulcer healing in patients with gastric ulcer, complicated duodenal ulcer, gastric MALT lymphoma or endoscopic resection of EGC. In patients with persistent symptoms or relapsing symptoms should be followed with endoscopy. Tests to confirm eradication of H. pylori should be delayed at least 4 weeks after completion of therapy. Serology is not useful to confirm the eradication of H. pylori. If endoscopy is indicated after treatment, obtaining multiple biopsy specimens from the gastric antrum, body and cardia is recommended for both urease testing and histology. The urea breath test is the test of choice to confirm eradication, if available. One or two weeks treatment of proton pump inhibitor (PPI) based triple therapy consisting of one PPI and two antibiotics, clarithromycin and amoxicillin, is recommended as the first line treatment regimen. Usage of metronidazole is not recommended because of high prevalence of its resistance in Korea. In the case of treatment failure, quadruple therapy (PPI+ classic bismuth triple) is recommended. Screening all dyspeptic patients for H. pylori infection is not recommended. Even dyspeptic patients who have been diagnosed as H. pylori-positive are not the candidates for eradication treatment, either. It is strongly recommended that dyspeptic patients over 30 years of age and those with alarm symptoms irrespective of age should be performed endoscopy to rule out the possibility of gastric cancer in Korea.

Diagnosis and Treatment of Helicobacter pylori Infection in Korea

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