Review of the Second Asia-Pacific Consensus Guidelines for Helicobacter pylori Infection
Kwong Ming Fock, MBBS, MMed (Int Med), FRCP (Edin), FRCP (London), FRACP, FACP, FAMS
Tiing Leong Ang, MBBS, MRCP (UK), MRCP (Edin), FAMS
Department of Gastroenterology, Changi General Hospital, Singapore, Singapore
The second Asia-Pacific Helicobacter pylori Consensus Guidelines provided an evidence-based management update. H. pylori eradication was recommended in peptic ulcer disease, early mucosa-associated lymphoid tissue type lymphoma, a family history of gastric cancer, functional dyspepsia, patients receiving long-term maintenance with a proton pump inhibitor (PPI) for gastroesophageal reflux disease, unexplained iron-deficiency anaemia or idiopathic thrombocytopenic purpura and patients at high risk of ulcers and ulcer-related complications prior to long-term aspirin or non-steroidal anti-inflammatory drug therapy. A population "test and treat" strategy for H. pylori infection in communities with a high incidence of gastric cancer was considered to be an effective strategy for gastric cancer prevention. The recommended first-line therapy for H. pylori infection in Asia remained PPI-based triple therapy with amoxicillin or metronidazole and clarithromycin for seven days. Bismuth-based quadruple therapy was considered an effective alternative. There appeared to be an increasing rate of resistance to clarithromycin and metronidazole in parts of Asia, leading to reduced efficacy of PPI-based triple therapy. Recommended salvage therapies included: (i) standard triple therapy that has not been previously used; (ii) bismuth-based quadruple therapy; (iii) levofloxacin-based triple therapy; and (iv) rifabutin-based triple therapy. Levofloxacin-based salvage therapy had an overall H. pylori eradication rate of 80% and appeared more efficacious than quadruple therapy with less adverse effects. A 10-day regimen was superior to a 7-day regimen.