Ivth Brazilian Consensus Conference on Helicobacter Pylori Infection

Abstract

Significant progress has been obtained since the III Brazilian Consensus Conference on H. pylori infection held in 2012, in Bento Gonçalves, Brazil, and justify a fourth meeting to establish updated guidelines on the current management of H. pylori infection. Therefore, the Núcleo Brasileiro para Estudo do Helicobacter pylori e Microbiota (NBEHPM), association linked to Brazilian Federation of Gastroenterology (FBG) held its fourth meeting again in Bento Gonçalves, RS, Brazil, on August 25-27, 2017. Twenty-six delegates, including gastroenterologists, endoscopists, and pathologists from the five regions of Brazil as well as one international guest from the United States, participated in the meeting. The participants were invited based on their knowledge and contribution to the study of H. pylori infection. The meeting sought to review different aspects of treatment for infection; establish a correlation between infection, dyspepsia, intestinal microbiota changes, and other disorders with a special emphasis on gastric cancer; and reassess the epidemiological and diagnostic aspects of H. pylori infection. Participants were allocated into four groups as follows: 1) Epidemiology and Diagnosis, 2) Dyspepsia, intestinal microbiota and other afections, 3) Gastric Cancer, and, 4) Treatment. Before the consensus meeting, participants received a topic to be discussed and prepared a document containing a recent literature review and statements that should be discussed and eventually modified during the face-to-face meeting. All statements were evaluated in two rounds of voting. Initially, each participant discussed the document and statements with his group for possible modifications and voting. Subsequently, during a second voting in a plenary session in the presence of all participants, the statements were voted upon and eventually modified. The participants could vote using five alternatives: 1) strongly agree; 2) partially agree; 3) undecided; 4) disagree; and 5) strongly disagree. The adopted consensus index was that 80% of the participants responded that they strongly or partially agreed with each statement. The recommendations reported are intended to provide the most current and relevant evidences to management of H. pylori infection in adult population in Brazil.

Saccharomyces boulardii as an adjuvant therapy for Helicobacter pylori eradication: A systematic review and meta‐analysis with trial sequential analysis

“…Probiotics are defined as live microorganisms that, when administered in sufficient amounts, confer a health benefit on the host . According to several recent consensus and guidelines on H pylori management, the efficacy of probiotics as an adjuvant therapy has not yet reached a definitive conclusion on H pylori eradication; certain probiotics may be beneficial to H pylori eradication; however, the quality of evidence was low or very low . The results of recent meta‐analyses were based on the pooled evidence of different probiotics strains, which may lead to misleading conclusions, as the efficacy of probiotics may be strain‐specific .…”

Métodos diagnósticos para detecção da infecção pelo h.pylori

“…A via iatrogênica é constituída principalmente por equipamentos esterilizados de forma incorreta ou não esterilizados, utilizados em exames de pessoas infectadas 2 . Os fatores de risco para a infecção por H.pylori são as más condições de vida, sanitárias e econômicas 3 .…”

“…Porém, o teste respiratório com 13C-uréia é o método de maior especificidade, sensibilidade e acurácia para diagnóstico de infecção por H. pylori. Em contrapartida, o teste do antígeno fecal usando os anticorpos monoclonais se apresenta como uma boa alternativa 3,8 .…”

Review: Treatment of Helicobacter pylori Infection 2019

“…More recently, a large-scale randomized trial from Taiwan compared the long-term changes of gut microbiota after 14-day triple therapy, 10-day concomitant therapy, and 10-day bismuth quadruple therapy. 83 The same could also be said of vonoprazan, which shows considerable promise and may even help partially overcome clarithromycin resistance but this will need to be robustly examined in regions outside Japan. 81 The αdiversity and β-diversity were restored to their pre-treatment state after week 8 in patients treated with triple therapy, but were not yet fully recovered at 1 year in patients treated with bismuth quadruple therapy and concomitant therapy.…”

“…on the basis that bismuth cannot be sourced in that country. 83 The same could also be said of vonoprazan, which shows considerable promise and may even help partially overcome clarithromycin resistance but this will need to be robustly examined in regions outside Japan.…”