Clinical Practice Guidelines of Russian Gastroenterological Association, Scientific Society for the Clinical Study of Human Microbiome, Russian Society for the Prevention of Non-Communicable Diseases, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy for <i>H. pylori</i> Diagnostics and Treatment in Adults

Abstract

Aim: bring to the attention of practitioners indications for anti-Helicobacter therapy, methods and procedure for diagnostics and eradication therapy of Н. pylori infection.Key points. Chronic gastritis caused by Н. pylori infection, including asymptomatic persons, may be considered as an indication for eradication therapy of Н. pylori as etiological therapy and opportunistic screening for gastric cancer prevention. Indications, for obligatory anti-Helicobacter therapy include peptic ulcer, gastric MALT lymphoma, early gastric cancer (EGC) with endoscopic resection. H. pylori primary diagnostics methods include 13C-urea breath test, H. pylori stool antigen lab test, rapid urease test and serological method. The serological method cannot be used after anti-Helicobacter therapy.In Russia H. pylori strains' resistance to clarithromycin does not exceed 15 % in most regional studies. The first line therapy for Н. pylori infection eradication is the standard triple therapy including a proton pump inhibitor (PPI), clarithromycin and amoxicillin, enhanced with bismuthate tripotassium dicitrate. A classic four-component therapy based on bismuthate tripotassium dicitrate or quadrotherapy without bismuth drug products which includes PPI, amoxicillin, clarithromycin and metronidazole, may be used as alternative to the first line eradication therapy. The standard triple therapy may be prescribed for 14 days only in those regions, where it has been proven to be effective. Quadrotherapy with bismuthate tripotassium dicitrate is also used as main second line therapy in case of standard triple therapy, bismuth enhanced standard triple therapy or combined therapy failure. Another second line therapy includes PPI, levofloxacin and amoxicillin, to which a bismuth-containing drug product may be added. The third line therapy is selected individually based on previously used treatment settings.Conclusion. In each case of H. pylori infection the decision for eradication therapy should be made, which is especially relevant as eradication of H. pylori has been recognized as an effective measure for the prevention of gastric cancer.

Efficacy and Safety of Postbiotic (Metabiotic) Contained Inactivated Lactobacillus reuteri (Limosilactobacillus Reuteri) DSM 17648 as Adjuvant Therapy in the Eradication of Helicobacter pylori in Adults with Functional Dyspepsia: A Randomized Double-

“…To increase еradication therapy efficacy, several methods have been proposed, including addition probiotics and mucosal protective agents such as rebamipide to standard eradication therapy. This complementation showed a positive effect [6][7][8][9].…”

“…[5]. Eradication therapy in these patients led to a decrease in the symptom severity in some patients but it is not always effective [1,6,7]. To increase еradication therapy efficacy, several methods have been proposed, including addition probiotics and mucosal protective agents such as rebamipide to standard eradication therapy.…”

Butyric Acid Supplementation Reduces Changes in the Taxonomic and Functional Composition of Gut Microbiota Caused by H. pylori Eradication Therapy

“…There is a clear need for H. pylori eradication in patients with gastrointestinal diseases, such as peptic ulcer disease, atrophic gastritis, and gastric MALToma. Moreover, it is now widely accepted that H. pylori -associated gastritis is an infectious disease, regardless of symptoms and complications, and that H. pylori eradication can cure gastritis and improve future prognosis [ 1 , 2 , 3 , 4 ]. In addition, the International Agency for Research on Cancer (IACR) of the World Health Organization classified H. pylori as a Group 1 carcinogen [ 5 ], considering the presence of H. pylori as a risk factor for gastric adenocarcinoma [ 6 , 7 ] and H. pylori -associated gastritis as a precancerous lesion [ 8 ].…”