Screening and eradication of Helicobacter pylori for gastric cancer prevention: The Taipei global consensus
Journal
Gut
Journal Volume
69
Journal Issue
12
Pages
2093-2112
Date Issued
2020
Author(s)
Malfertheiner P.
Sheu B.-S.
Sugano K.
Cheng H.-C.
Yeoh K.-G.
Hsu P.-I.
Goh K.-L.
Mahachai V.
Gotoda T.
Chang W.-L.
Wu C.-Y.
Leow A.H.-R.
Wu J.-Y.
Wu D.-C.
Lu H.
Yamaoka Y.
Megraud F.
Chan F.K.L.
Sung J.J.Y.
Lin J.-T.
Graham D.Y.
El-Omar E.M.
Abstract
Objective A global consensus meeting was held to review current evidence and knowledge gaps and propose collaborative studies on population-wide screening and eradication of Helicobacter pylori for prevention of gastric cancer (GC). Methods 28 experts from 11 countries reviewed the evidence and modified the statements using the Delphi method, with consensus level predefined as ?80% of agreement on each statement. The Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach was followed. Results Consensus was reached in 26 statements. At an individual level, eradication of H. pylori reduces the risk of GC in asymptomatic subjects and is recommended unless there are competing considerations. In cohorts of vulnerable subjects (eg, first-degree relatives of patients with GC), a screen-and-treat strategy is also beneficial. H. pylori eradication in patients with early GC after curative endoscopic resection reduces the risk of metachronous cancer and calls for a re-examination on the hypothesis of a € the point of no return'. At the general population level, the strategy of screen-and-treat for H. pylori infection is most cost-effective in young adults in regions with a high incidence of GC and is recommended preferably before the development of atrophic gastritis and intestinal metaplasia. However, such a strategy may still be effective in people aged over 50, and may be integrated or included into national healthcare priorities, such as colorectal cancer screening programmes, to optimise the resources. Reliable locally effective regimens based on the principles of antibiotic stewardship are recommended. Subjects at higher risk of GC, such as those with advanced gastric atrophy or intestinal metaplasia, should receive surveillance endoscopy after eradication of H. pylori. Conclusion Evidence supports the proposal that eradication therapy should be offered to all individuals infected with H. pylori. Vulnerable subjects should be tested, and treated if the test is positive. Mass screening and eradication of H. pylori should be considered in populations at higher risk of GC. ? 2020 BMJ Publishing Group. All rights reserved.
SDGs
Other Subjects
antibiotic agent; antiinfective agent; proton pump inhibitor; antimicrobial stewardship; asymptomatic disease; atrophic gastritis; bacterial clearance; cancer incidence; cancer prevention; cancer risk; cancer screening; colorectal cancer; consensus; cost effectiveness analysis; Delphi study; endoscopic surgery; first-degree relative; gastroscopy; Helicobacter infection; high risk patient; human; intestine metaplasia; medical expert; nonhuman; priority journal; Review; risk reduction; screening; stomach atrophy; stomach cancer; Taiwan; vulnerable population; antibiotic resistance; atrophic gastritis; clinical decision making; consensus development; cost benefit analysis; dose response; drug administration; early cancer diagnosis; gastroesophageal reflux; gastrointestinal endoscopy; genetic marker; global health; Helicobacter infection; Helicobacter pylori; intestine flora; metabolic syndrome X; metaplasia; microbiology; reinfection; stomach tumor; Anti-Bacterial Agents; Antimicrobial Stewardship; Clinical Decision-Making; Cost-Benefit Analysis; Delphi Technique; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Resistance, Bacterial; Early Detection of Cancer; Endoscopy, Gastrointestinal; Gastritis, Atrophic; Gastroesophageal Reflux; Gastrointestinal Microbiome; Genetic Markers; Global Health; Helicobacter Infections; Helicobacter pylori; Humans; Metabolic Syndrome; Metaplasia; Proton Pump Inhibitors; Reinfection; Stomach Neoplasms
Publisher
BMJ Publishing Group
Type
review