Since the World Health Organization classified H. pylori as a group I carcinogen, detection and eradication of H. pylori has become a hot topic in the treatment of GI diseases. The current eradication rate of standard triple therapy is well below 80% in most parts of the world and does not meet the treatment needs, mainly due to the increasing rate of antibiotic resistance of H. pylori to treatment regimens as a result of irregularities in detection and treatment.
Therefore, strict adherence to the indications for H. pylori eradication treatment, selection of the correct detection method, appropriate treatment regimen, and strict adherence to medical prescriptions for standardized medication use are important factors in addressing the low H. pylori eradication rate.
Strictly grasp the indications for H. pylori eradication
Any disease where H. pylori eradication can benefit the patient can be treated with eradication. There are two general categories.
One is diseases associated with H. pylori positivity: including peptic ulcer, gastric mucosa-associated lymphoid tissue lymphoma (MALT), chronic gastritis with dyspeptic symptoms or with gastric mucosal atrophy or erosion, lymphocytic gastritis, gastric hyperplastic polyps, Menetrier’s disease, unexplained iron deficiency anemia, and idiopathic thrombocytopenic purpura.
Second, patients with specific personal and family histories: including long-term use of proton pump inhibitors, planned long-term use of non-steroidal anti-inflammatory drugs including low-dose aspirin, family history of gastric cancer or those who have undergone endoscopic resection or subtotal gastrectomy for early gastric tumors.
In cases where these conditions do not exist and the individual requests treatment, H.pylori eradication is supported if the individual is <45 years of age and does not have alarming symptoms such as gastrointestinal bleeding, persistent vomiting, wasting, dysphagia, painful swallowing, or abdominal masses, or if the individual is ≥45 years of age or has alarming symptoms, gastroscopy is required.
Diagnosis of H.pylori infection
The diagnosis of H.pylori infection is currently recommended if any one of the following three criteria is met.
(1) A positive rapid urease test (RUT), staining of tissue sections, or culture of any of the following three;
(2) Positive 13C or 14C urea breath test (UBT);
(3) Positive fecal H.pylori antigen test (HpSA) and positive serum H.pylori antibody test indicate previous infection, and those who have never been treated can be considered as presenting infection.
Review after eradication therapy for H.pylori infection should be done at least 4 weeks after completion of eradication therapy, UBT is preferred. H.pylori clearance therapy is considered successful if any one of the following three items is met.
(1) 13C or 14C urine UBT negative;
(2) Negative HpSA test;
(3) negative RUT based on both sinus and gastric body sampling.
During the detection of H. pylori infection, it should be noted that
1. The accuracy of different detection reagents varies, and the selected reagents and methods must be clinically validated;
2, RUT test results are affected by the pH value of reagents, sampling site, tissue size, bacterial amount, observation time, ambient temperature and other factors. It is recommended that a piece of tissue be taken from the sinus and body of the stomach for testing to improve the sensitivity of the test. When patients undergo gastroscopy, RUT is recommended to be performed routinely.
3. The results of UBT are unreliable when the value is near the critical value, and can be tested again after a period of time or by other methods. The results of UBT in patients with residual stomach are unreliable.
4. Avoid the influence of certain drugs, such as antibacterial drugs, bismuth and some Chinese herbal medicines with antibacterial effect, when testing. The test should be performed at least 4 weeks after stopping the drug. Acid suppressants should be tested at least 2 weeks after stopping the medication.
5, different disease states can also affect the test results, such as peptic ulcer active bleeding, severe atrophic gastritis, gastric malignant tumors may affect the RUT, UBT results, can be tested at different times, using a variety of methods to obtain more reliable results.
6, the detection rate of H.pylori in the gastric mucosa intestinal septic tissue is low. Therefore, it is highly suggestive of H.pylori infection when active inflammation is present. Patients with active peptic ulcer have >95% chance of H.pylori infection after excluding the use of NSAIDs and aspirin.