Diagnosis and Treatment Guidelines for Helicobacter pylori Infection in Korea

Abstract

Eleven years has passed since the guideline of the Korean College of Helicobacter and Upper Gastrointestinal Research group for H. pylori infection was produced in 1998. During this period the research for H. pylori has much progressed that H. pylori is now regarded as the major cause of gastric cancer. The seroprevalence of H. pylori in Korea was found to be decreased especially below the age of 40s and in the area of Seoul-Gyeonggi province, and annual reinfection rate of H. pylori has decreased up to 2.94%. In the aspect of diagnostic tests of H. pylori the biopsy is recommended in the body instead of antrum in the subjects with atrophic gastritis and/or intestinal metaplasia for the modified Giemsa staining or Warthin Starry silver staining. The urea breath test is the test of choice to confirm eradication when follow-up endoscopy is not necessary. Definite indication for H. pylori eradication is early gastric cancer in addition to the previous indications of peptic ulcer including scar and Marginal zone B cell lymphoma (MALT type). Treatment is also recommended for the relatives of gastric cancer patient, unexplained iron deficiency anemia, and chronic idiopathic thrombocytopenic purpura. One or two week 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. In the case of treatment failure, one or two weeks of quadruple therapy (PPI+metronidazole+tetracycline+bismuth) is recommended. Herein, Korean College of Helicobacter and Upper Gastrointestinal Research proposes a diagnostic and treatment guideline based on currently available evidence.

The first-line regimens of Helicobacter pylori eradication in Korea

“…Korean guidelines, which were revised in 2013, by the Korean College of Helicobacter and Upper Gastrointestinal Research strongly recommend that H. pylori should be eradicated in patients with peptic ulcer disease, gastric MALT lymphoma, endoscopically treated early gastric cancer, and immune thrombocytopenic purpura [4]. Identification of optimal regimen of H. pylori eradication has been a challenge for gastroenterologists.…”

“…Twenty years ago, one comparative study showed that proton pump inhibitor (PPI)-based triple therapy, that consisted of PPI, amoxicillin, and metronidazole, had superior efficacy for H. pylori eradication among various regimens based on PPI, bismuth, amoxicillin, and metronidazole [5]. In addition, conventional triple therapy, that consists of PPI, amoxicillin, and clarithromycin, has been widely used in Korea because of the high resistance rate of H. pylori against metronidazole [4,6,7]. This conventional triple therapy for 7-14 days is also a world-wide choice for H. pylori eradication [8,9].…”

“…However, eradication of conventional triple therapy has decreased over the past 10 years [10,11], caused by resistance against clarithromycin [12]. Alternatively, many eradication regimens including sequential therapy, concomitant therapy, and hybrid therapy have been suggested [4]. Despite of the insufficient eradication rate of the conventional triple therapy, the current Korean guideline still recommends conventional triple therapy as a first-line therapy for H. pylori infection because superior efficacy of alternative regimens over the conventional triple therapy has not been fully evaluated [4].…”

“…Alternatively, many eradication regimens including sequential therapy, concomitant therapy, and hybrid therapy have been suggested [4]. Despite of the insufficient eradication rate of the conventional triple therapy, the current Korean guideline still recommends conventional triple therapy as a first-line therapy for H. pylori infection because superior efficacy of alternative regimens over the conventional triple therapy has not been fully evaluated [4]. Recently, however, the Maastricht V/Florence Consensus Report stated that PPI-clarithromycin-containing triple therapy without prior susceptibility testing should be abandoned when the clarithromycin resistance rate in the regions is more than 15% [13].…”

Vonoprazan-Based Helicobacter pylori Eradication Therapy: Time to Get Kompetitive?

“…Eradication of H. pylori is the first option for the treatment of low-grade gastric MALT lymphoma. Furthermore, H. pylori eradication reduces the recurrence of peptic ulcer [4]. A recent Cochrane review reported that the risk of gastric cancer may be reduced through H. pylori eradication, particularly in Asia [5].…”