According to our “Fourth National Consensus Report on the Management of Helicobacter pylori Infection”, we would like to provide the following information for our patients to learn together.
1. Patients with peptic ulcer.
Hp eradication is the most important indication. Hp eradication can promote ulcer healing and significantly reduce the recurrence rate and complication rate of ulcers. Hp eradication makes the majority of peptic ulcers no longer a chronic, recurrent disease, but completely curable.
2. Patients with gastric MALT lymphoma.
It is a rare malignant tumor of the stomach, about 80% or more Hp positive, early stage (lesions limited to the mucosal layer or submucosal layer) of gastric MALT lymphoma can obtain a complete response after Hp eradication, but the efficacy is reduced for lesions deeper than the submucosal layer. Hp eradication has become the first-line treatment for Hp-positive early gastric MALT lymphoma.
3. Hp-positive chronic gastritis with dyspepsia.
Hp eradication can provide long-term symptom relief in 8%-20% of Hp-positive FD patients, and this efficacy is better than any other treatment.
4, chronic gastritis with gastric mucosal atrophy or erosion.
Intestinal gastric cancer eventually occurs in <1% of Hp-infected patients, and atrophy and intestinalization are important lesion stages in the evolution from non-atrophic gastritis to gastric cancer. Atrophy and intestinal chemosis can occur after recurrent erosion. Although the best time to eradicate Hp to prevent gastric cancer is before the occurrence of atrophy and intestinal chemosis, eradication of Hp at this stage can still eliminate the inflammatory response, slow down or stop the development of atrophy, and possibly reverse part of the atrophy, but intestinal chemosis is difficult to be reversed.
5.Early gastric tumor has been resected endoscopically or surgically by subtotal gastrectomy.
6.Patients who need to take proton pump inhibitor (PPI) for a long time.
Long-term administration of PPI in Hp-infected patients may cause a change in the type of gastritis from sinus-based gastritis to gastric body-based gastritis. This is because the rise in gastric pH after taking PPI facilitates the displacement of Hp from the gastric sinus to the gastric body, and the inflammation and atrophy of the gastric body further reduces gastric acid secretion. The risk of gastric cancer is significantly higher in gastric body atrophy-based low or acid-free gastritis.
7. Family history of gastric cancer.
Except for a small number (about 1%-3%) of hereditary diffuse gastric cancer, the occurrence of most gastric cancers is the result of the combination of Hp infection, environmental factors and genetic factors. Although it is difficult to change the genetic susceptibility, eradication of Hp can eliminate the important factors for the development of gastric cancer and thus improve the prevention effect.
8. Patients planning to take long-term non-steroidal anti-inflammatory drugs (NSAIDs) (including low-dose aspirin).
Hp infection and taking NSAIDs, including aspirin, are two independent risk factors for the development of peptic ulcer.
9. Hp infection is associated with iron deficiency anemia of unknown origin.
Hp eradication increases hemoglobin levels, and Hp eradication increases platelet counts in more than 50% of patients with idiopathic thrombocytopenic purpura.
10. Individual request for treatment.
Circumstances and benefits vary and should be critically evaluated by a physician prior to treatment. Those aged <45 years with no alarm symptoms support Hp eradication, but those aged >45 years or with alarm symptoms require endoscopy first. The potential risks of this management strategy, including missed upper gastrointestinal cancers, masking and adverse drug reactions, need to be clearly explained to the patient prior to treatment.
Are you among them? If so, see your doctor soon and be sure to standardize your treatment!