Treatment of Helicobacter pylori Infection. William D. Chey, MD, FACG1, Grigorios I. Leontiadis, MD, Ph. D2, Colin W. Howden, MD, FACG3, and Steven F. Moss, MD, FACG4. 1Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA; 2. Division of Gastroenterology, Mc. Master University, Hamilton, Ontario, Canada; 3. Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, Tennessee, USA; and 4. Division of Gastroenterology, Warren. Alpert Medical School of Brown University, Providence, Rhode Island, USAAm J Gastroenterol 2. January 2. 01. 7Received 2. June 2. 01. 6; accepted 7 October 2. Correspondence: William D. Chey, MD, FACG, Timothy T. Nostrant Professor of Gastroenterology and Nutrition Sciences, Division of Gastroenterology, University of Michigan Health System, 3. Taubman Center, SPC 5. Ann Arbor, Michigan 4. USA. E- mail: wchey@umich. Abstract. Helicobacter pylori (H. While choosing a treatment regimen for H. For first- line treatment, clarithromycin triple therapy should be confined to patients with no previous history of macrolide exposure who reside in areas where clarithromycin resistance amongst H. Most patients will be better served by first- line treatment with bismuth quadruple therapy or concomitant therapy consisting of a PPI, clarithromycin, amoxicillin, and metronidazole. When first- line therapy fails, a salvage regimen should avoid antibiotics that were previously used.
Irritable bowel syndrome (IBS) is common in the general population and has a significant medical and socioeconomic impact. Its pathophysiology is still not entirely. We won't share your email address. Unsubscribe anytime. JOBS and CAREER - weekly newsletter - Follow @JobsandCareer. Product Number: Product Title: Prescribing Pub: Format: Date: Size: AF100: REQUEST AND AUTHORIZATION FOR SEPARATION: AFI36-2102: 1: 11/7/2012 12:00:00 AM: 46.13kB: 957. Conclusions. The low-carbohydrate diet produced a greater weight loss (absolute difference, approximately 4 percent) than did the conventional diet for the first six. Coordinating Care for Patients With Chronic HF: Recommendations e295 11.2. Systems of Care to Promote Care Coordination for Patients With Chronic HF e296 11.3. If a patient received a first- line treatment containing clarithromycin, bismuth quadruple therapy or levofloxacin salvage regimens are the preferred treatment options. If a patient received first- line bismuth quadruple therapy, clarithromycin or levofloxacin- containing salvage regimens are the preferred treatment options. Details regarding the drugs, doses and durations of the recommended and suggested first- line and salvage regimens can be found in the guideline. Introduction. Helicobacter pylori infection remains one of the most common chronic bacterial infections affecting humans. Since publication of the last American College of Gastroenterology (ACG) Clinical Guideline in 2. H. The most significant advances have been made in the arena of medical treatment. Thus, this guideline is intended to provide clinicians working in North America with updated recommendations on the treatment of H. For the purposes of this document, we have defined North America as the United States and Canada. Whenever possible, recommendations are based upon the best available evidence from the world’s literature with special attention paid to literature from North America. When evidence from North America was not available, recommendations were based upon data from international studies and expert consensus. This guidance document was developed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system (1), which provides a level of evidence and strength of recommendation for statements developed using the PICO (patient population, intervention or indicator assessed, comparison group, outcome achieved) format. At the start of the guideline development process, the authors developed PICO questions relevant to Helicobacter pylori infection. The authors worked with research methodologists from Mc. Master University to conduct focused literature searches to provide the best available evidence to address the PICO questions. Databases searched included MEDLINE, EMBASE and Cochrane CENTRAL from 2. September 2. 01. 4. Search terms included “pylori, treat*, therap*, manag*, eradicat*”. The full literature search strategy is provided as Supplementary Appendix 1 online. After assessing the risk of bias, indirectness, inconsistency, and imprecision, the level of evidence for each recommendation was reported as “high” (further research is unlikely to change the confidence in the estimate of effect), “moderate” (further research would be likely to have an impact on the confidence in the estimate of effect), “low” (further research would be expected to have an impact on the confidence in the estimate of effect), or “very low” (any estimate of effect is very uncertain). The strength of recommendations was determined to be “strong” or “conditional” based on the quality of evidence, the certainty about the balance between desirable and undesirable effects of the intervention, the certainty about patients’ values and preferences, and the certainty about whether the recommendation represents a wise use of resources. A summary of the recommendation statements for this management guideline is provided in Table 1. The justification for the assessments of the quality of evidence for each statement can be found in Supplementary Appendix 2 online. Table 1. Recommendation statements. What is known about the epidemiology of H. Which are the high risk groups? H. The exact means of acquisition is not always clear. The incidence and prevalence of H. Within North America, the prevalence of the infection is higher in certain racial and ethnic groups, the socially disadvantaged, and people who have immigrated to North America (Factual statement, low quality of evidence). What are the indications to test for, and to treat, H. Those who test positive should be offered treatment for the infection (Strong recommendation; quality of evidence: high for active or history of PUD, low for MALT lymphoma, low for history of endoscopic resection of EGC). In patients with uninvestigated dyspepsia who are under the age of 6. H. Those who test positive should be offered eradication therapy (conditional recommendation; quality of evidence: high for efficacy, low for the age threshold). When upper endoscopy is undertaken in patients with dyspepsia, gastric biopsies should be taken to evaluate for H. Infected patients should be offered eradication therapy (strong recommendation; high quality of evidence). Patients with typical symptoms of gastroesophageal reflux disease (GERD) who do not have a history of PUD need not be tested for H. However, for those who are tested and found to be infected, treatment should be offered, acknowledging that effects on GERD symptoms are unpredictable (strong recommendation; high quality of evidence). In patients taking long- term, low- dose aspirin, testing for H. Those who test positive should be offered eradication therapy to reduce the risk of ulcer bleeding (conditional recommendation; moderate quality of evidence). Patients initiating chronic treatment with a non- steroidal anti- inflammatory drug (NSAID) should be tested for H. Those who test positive should be offered eradication therapy (Strong recommendation; Moderate quality of evidence). The benefit of testing and treating H. Those who test positive should be offered eradication therapy (conditional recommendation; low quality of evidence). Adults with idiopathic thrombocytopenic purpura (ITP) should be tested for H. Those who test positive should be offered eradication therapy (conditional recommendation; very low quality of evidence). There is insufficient evidence to support routine testing for and treatment of H. Bismuth quadruple therapy is particularly attractive in patients with any previous macrolide exposure or who are allergic to penicillin (strong recommendation; low quality of evidence). Concomitant therapy consisting of a PPI, clarithromycin, amoxicillin and a nitroimidazole for 1. Sequential therapy consisting of a PPI and amoxicillin for 5–7 days followed by a PPI, clarithromycin, and a nitroimidazole for 5–7 days is a suggested first- line treatment option (conditional recommendation; low quality of evidence (for duration: very low quality of evidence)). Hybrid therapy consisting of a PPI and amoxicillin for 7 days followed by a PPI, amoxicillin, clarithromycin and a nitroimidazole for 7 days is a suggested first- line treatment option (conditional recommendation; low quality of evidence (For duration: very low quality of evidence)). Levofloxacin triple therapy consisting of a PPI, levofloxacin, and amoxicillin for 1. For duration: very low quality of evidence)). Fluoroquinolone sequential therapy consisting of a PPI and amoxicillin for 5–7 days followed by a PPI, fluoroquinolone, and nitroimidazole for 5–7 days is a suggested first- line treatment option (conditional recommendation; low quality of evidence (for duration: very low quality of evidence)). What factors predict successful eradication when treating H. Organized efforts are needed to document local, regional, and national patterns of resistance in order to guide the appropriate selection of H. Selection of best salvage regimen should be directed by local antimicrobial resistance data and the patient’s previous exposure to antibiotics (Conditional recommendation; for quality of evidence see individual statements below). Clarithromycin or levofloxacin- containing salvage regimens are the preferred treatment options, if a patient received first- line bismuth quadruple therapy. Selection of best salvage regimen should be directed by local antimicrobial resistance data and the patient’s previous exposure to antibiotics (Conditional recommendation; for quality of evidence see individual statements below). The following regimens can be considered for use as salvage treatment: Bismuth quadruple therapy for 1. After failure of first- line therapy, such patients should be considered for referral for allergy testing since the vast majority can ultimately be safely given amoxicillin- containing salvage regimens (strong recommendation; Low quality of evidence). Question 1: What Is Known About the Epidemiology of H. Which Are the High- Risk Groups? Recommendation. H. The exact means of acquisition is not always clear. The incidence and prevalence of H. Within North America, the prevalence of the infection is higher in certain racial and ethnic groups, the socially disadvantaged, and people who have immigrated to North America (factual statement, low quality of evidence).
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