<aside> 📘 Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022

</aside>

<aside> 📘 The Taiwan guideline for screening and eradication of Helicobacter pylori infection for gastric cancer prevention. 2022

</aside>

Indication

• Indication that suggest H. pylori eradication

  Condition	Details
  Dyspepsia	H. pylori gastritis has to be excluded before a diagnosis of functional dyspepsia can be made.
  IDA	Improve anemia and increase hemoglobin levels, especially in those with moderate to severe anemia. More pronounced benefits in children.
  ITP	ITP patients with atrophic gastritis are more likely to respond to H. pylori eradication therapy. More pronounced benefits in adult.
  Vitamin B12 Malabsorption	Chronic H. pylori infection has been linked to malabsorption of vitamins, including vitamin B12.
  NSAID, aspirin users	H. pylori infection increase the risk of peptic ulcer disease in NSAIDs, COX2-inhibitors, or aspirin.
  MALT-Lymphomas	70%–80% long-term remission rates. Cases with the 11:18 translocation are unlikely to respond to H. pylori eradication therapy.

Diagnostics

General population Surveillance

• A meta-analysis of seven randomized controlled trials (RCTs) with 8,323 asymptomatic participants showed that H. pylori eradication therapy reduced the incidence of gastric cancer.
• Population-based H. pylori test-and-treat programs are recommended, especially in high-incidence areas

In young dyspeptic patients (age below 50)

• Suggest non-Invasive Tests for H. pylori

  Test	Sensitivity	Specificity	Note
  Urea Breath Test (UBT)	83% - 95%	91% - 100%	Avoid PPI for at least 2 weeks and antibiotics for at least 4 weeks
  Stool Antigen Test	88.9% - 94.3%	93% - 95.9%	Simple and easy
  Anti-H. pylori IgG	85-90%	79%	Cannot differentiate between active and past infections

In older dyspeptic patients (age beyond 50)

• In most countries, especially those with high rates, gastric cancer incidence significantly increases after age 50.

• Suggest upper gastrointestinal (GI) endoscopy for invasive H.P. test and Gastric Mucosal Atrophy evaluation

• Invasive Tests for H. pylori

  Test	Sensitivity	Specificity	Note
  Histology biopsy	92%	92%	Also assess the severity of gastritis and the presence of precancerous lesions
  Rapid Urease Test (CLO test)	87%	95%	Avoid PPI for at least 2 weeks and antibiotics for at least 4 weeks
  Culture	90%	98%	Suggest for resistance evaluation

Gastric mucosal atrophy

• Gastric mucosal atrophy is a risk factor for non-hereditary/non-syndromic gastric adenocarcinoma.
• Two types of atrophy:
  • Gland loss: Disappearance of glandular units, replaced by fibrosis.
  • Metaplastic replacement: Include Intestinal metaplasia (IM) and Pseudopyloric metaplasia

Endoscopy evaluation