The new version of the Chinese Helicobacter pylori infection therapy guide has said, this is a good look!

For medical professionals for reading reference

The latest expert interpretation!

Recently, the much -watched "Sixth National Helicobacter Cleecinobacter Pylori Infection Treatment Consensus Report (Non -eraded Treatment Part)" (hereinafter referred to as the National Six Consensus) has been officially seen. In response to the treatment of Helicobacter pylori (HP) infection, the expert group for the first time has formulated a guide to higher evidence level for the first time, and it is currently being published. In order to better and more standardized the promotion of the Sixth Edition consensus/guide, the Chinese Medical Association Gastrointestinal Society of the Helicobacter Pymiology Group also held a national tour of the National Six Edition Consensus/Guide on June 11th. It is expected to improve the standardized diagnosis and treatment level of clinicians in this field on HP infection and benefit the majority of patients.

At the launch meeting, the "HP infection Treatment" was introduced and interpreted by Professor Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine. The first time this article summarizes the problems facing HP infection treatment, the academic focus of the guide for your reference and learning. For the specific content of the guide, please refer to the full text after the publication.

HP infection treatment:

Based on problems, based on evidence

The new version of the HP infection treatment guide is based on the best evidence at home and abroad that can be obtained at present, and adopts the evaluation, formulation and evaluation system of evidence and recommended grades to fully consider the patient's will and values. Recommended opinions are formed after factors such as sex and cost benefits. The new version of the guidelines answered important clinical issues such as HP's initial and re -treatment (non -first -tier, second line), in order to give evidence -based recommendations on the basis of clinical practice.

1

Among HP infections, compared to the three -united scheme, is it recommended that the four -link plan for the doses as the first and reinforcement?

Recommended opinion: Recommended the four -link plan for the pyrine as the first and re -treatment of the HP infection. (Strong recommendation, secondary quality evidence)

Except for proton pump inhibitors (PPI) and pupae, the following antibacterial drug combinations (sorting are not distinguished) amoxicillin combined with craticin, amoxicillin combined with levofloxacin Tanibalzazole, amoxicillin combined with tetracycline. (Strong recommendation, secondary quality evidence)

The recommended antibacterial drug combination, dose, and usage in the recommended pupae four -link schemes are as shown in the figure below, which is consistent with the consensus of the Fourth and Fourth Editions of the country.

Note: The standard dose of PPI and pupae (2 times/day, half an hour before the meal) combined with two antibacterial drugs (oral after meals) for 14 days.

Recommended opinions: In the initial and re -treatment, the non -tadpole four -link scheme (accompanied by the same scheme, hybrid plan, sequential plan).

2

Among the HP infection, compared to the four -link scheme of the tadpole, is it recommended that a large dose of two -link schemes are recommended as the first and re -treatment?

Large -dose binary scheme refers to the solution that contains double -dose PPI and daily ≥3 g (3 times or more) amoxicillin, with a course of treatment for 14 days.

Recommended opinions: In the first and re -treatment of HP infected people, the four -sectum and large dose of dose of doses are available for optional treatment solutions. (Strong recommendation, low quality evidence)

How to further optimize the HP cure solution and increase HP eradication rate is a clinical issue that needs to be continuously explored and verified. Compared with the therapy of the four coupons, the adverse reactions of the diet therapy are significantly lower. It is a simple and low -drug resistance scheme, or it can be used for first -line or saving treatment.

However, the two -linked application for the intensity of acid suppression is also higher. Amoxicillin has pH dependence on HP's antibacterial effect. When gastric acid is fully suppressed in gastric acid, the level of pH in the stomach can continue or at the level of more than 6 or more in the day. Give play to the role of killing HP, the more fully the gastric acid secretion is suppressed, the higher the effect of Angorin's antibacterial effect. Therefore, the clinical clinical should be used for acid suppression drugs with higher acidic effects for this solution.

3

Among the HP infection, compared to the conventional dose of PPI, is it recommended that double dose PPI four -sects are recommended?

According to the types and specifications of PPI drugs in my country, the PPIs used in eradication are single doses, and the four -link scheme of the pupae is taken twice a day.

Recommended opinions: It is not recommended to use double dose PPI in the four -link scheme of the tadpole. (Weak recommendation, secondary quality evidence)

Implementation suggestions: In some cases, when the CYP2C19 genotype detection has clearly specified that the HP infection is a PPI fast metabolic type, you can use the double -dose PPI four -sector to eliminate the treatment as appropriate, which may help improve the root cause of the root cause.

4

Among the HP infection, compared to the PPI -containing pyrine four -link scheme, is it recommended to recommend potassium -containing ion competitive stasis four -meter four -link schemes?

Recommended opinions: In the root era treatment of HP infected people, the PPI-containing pupae four-link scheme and P-CAB's pupae four-link scheme are optional schemes for eradication treatment. (Weak recommendation, low quality evidence)

As the first P-CAB listed in my country, Fonola has the advantages of suppressing acid suppression, fast-acting, long-term effects, and not affected by meals. The bactericidal ability and increase the HP eradication rate. It has been successfully applied to the first and second -line eradication since its listing in Japan in 2014. The indications of HP root treatment will also be approved in my country in the future, and will provide more choices for the root treatment of HP infected by HP infection in my country.

5

In the empirical eradication treatment of HP infected people, is it recommended to eliminate the root era treatment plan that understands the history of antibiotics? Recommended opinion: In the experienced rootting treatment of HP infected people, it is recommended to use root era treatment schemes that understand the history of antibiotics. (Strong recommendation, secondary quality evidence)

Implementation suggestions: There may be uncertainty of the medical history information obtained through the memory of patients, resulting in damage to the effectiveness of the intervention measures. It is recommended to obtain the patient's electronic medical record data as much as possible during the implementation process.

6

Among HP infections, compared to experience eradication treatment, is it recommended for individualized root era treatment solutions under the guidance of drug sensitivity testing?

Recommended opinions: In the initial treatment of HP infected people, the guide group does not recommend the individual eradication plan for regular use of drug sensitivity testing guidance. (Weak recommendation, secondary quality evidence)

Implementation suggestions: Although there is no research evidence of the treatment of the loser in the current research evidence, guidelines for the establishment of an individualized rootting treatment plan under the guidance of drug sensitivity testing in such patients.

7

In the HP infection, compared to the treatment of the four -meter plan of the pyrine, is it recommended that the four -reciprocal scheme for the pyramids combined with traditional Chinese medicine treatment?

Recommended opinions: 1. Craptycin, levofloxacin, metronidazole high -resistant areas, when using experienced treatment; 2. Among the patients who have eliminated HP treatment failure, some Chinese medicines are combined on the basis of the four -reciprochemical solution of the pupae, It may help improve the root era. (Condition recommendations, low quality evidence)

8

Among the HP infection, compared to the four -united scheme of the tadpole, is it recommended that the three -link plan combined with probiotics for probiotics?

Recommended opinions: At present, there is no reliable research evidence to support or oppose the use of triad root removal schemes in HP infection treatment. (No recommendation, extremely low quality evidence)

9

Among those with HP infection, compared to the four -link scheme of the pyrine, is it recommended that the four -link scheme of the pyrine combined with probiotic treatment?

Recommended opinion: Conditional Recommended Four -Unicus Four Unicus Combined Propers Genogen to remove HP infection. (Condition recommendations, secondary quality evidence)

10

Among the HP infection, compared to the four -connected scheme of the pyrine, is it recommended for the treatment plan for the three -link plan with gastric mucosa protective agent?

Recommended opinions: It is not recommended to use the standard three -combined gastric mucosal protective agent scheme to replace the standard four -link plan for HP root eradication. (Weak recommendation, expert consensus)

11

Difficulty HP infection root treatment

The definition of refractory HP infection: It refers to the treatment of different drug combination schemes that are continuously regulated and have not succeeded in the treatment of ≥ 2 times.

reason:

▪ strain factors: primary and secondary drugs;

▪ Host factor: CYP2C19 gene polymorphism; allergies such as penicillin and other drugs; poor compliance;

▪ Doctors: irregular treatment.

Recommended opinion: For those who are difficult to cure HP infection:

(1) It is recommended to use the four -sector plan for an experience to eliminate the treatment. In addition to PPI and pyrine. It can be combined with the following antibacterial drugs: tetracycline+metronidazole, amoxicillin+amuoloone, tetracycline+amuoloone, amoxylin+tetracycline, amoxicillin+metronidazole, for 14 days.

(2) In terms of conditions, it is recommended to perform individualized diagnosis and treatment of bacterial culture and antibiotic sensitivity testing. (Weak recommendation, expert consensus)

12

HP infection treatment of patients with penicillin allergy

Recommended opinions: For patients with penicillin allergies, the first choice of tetracycline combined with metinidazole is used as an experienced rootting treatment plan.

▪ 14 days for treatment.

▪ Clinical clinical clinical cordicillin, levloxacin, and metronidazole are commonly used. The effect is generally not good, but when the full -dose metronidazole (1.6g/day) is used, better root eradication may be obtained. (Weak recommendation, expert consensus)

▪ Use semi -synthetic tetracycline to replace tetracycline. (For example, Mino Circle 100 Mg, 2 times/day)

In summary, in the context of high antibiotic resistance rate, the current four-link plan of my country's characteristics is still the first choice; high-dose amoxicillin-PPI scheme is also a choice; individualization under the guidance of drug sensitivity testing guidance The treatment plan can be performed and recommended under conditions. In the empirical eradication treatment of HP infected people, it is recommended to understand the root causes of antibiotic medication history adjustment. Finally, it is necessary to pay attention to the treatment of those infected with the cure.

Expert Introduction

Professor Lu Hong

Chief Physician, Ph.D., Doctor of Medicine, Doctor of Medicine, Ph.D.

Deputy Director of Shanghai Institute of Gastroenterology

Deputy Director of the Key Laboratory of the Ministry of Health

Deputy Leader of the Helicobacter Study Group of the Chinese Medical Association Gastroenterology Branch

I have been engaged in post -doctoral research at Baylor College of Medicine

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