The study from the American College of Gastroenterology (ACG) no longer recommends proton pump inhibitors (PPIs) as the preferred treatment for H. pylori infections.
Instead, bismuth quadruple therapy (BQT) is now the first-line treatment due to rising antibiotic resistance, particularly to clarithromycin and levofloxacin.
Bismuth quadruple therapy (BQT) for H. pylori includes the following agents:
Bismuth subsalicylate 300 mg, take 1 tablet four times daily.
Tetracycline 500 mg, take 1 tablet four times daily.
Metronidazole 500 mg, take 1 tablet three times daily.
H2-receptor antagonist (e.g., famotidine 20 mg), take 1 tablet twice daily.
Interventions Compared:
Various therapies including proton pump inhibitor (PPI)-clarithromycin triple therapy, bismuth quadruple therapy (BQT), rifabutin-triple therapy, PCAB therapies, and quinolone-based therapies.
BQT was recommended as the preferred regimen for both treatment-naïve and experienced patients.
Results:
Optimized Bismuth-Based Quadruple Therapy (BQT) for 14 days is recommended for treatment-naïve and patients who failed prior treatments.
Alternatives include rifabutin-based triple therapy and vonoprazan-amoxicillin dual therapy.
PPI-clarithromycin triple therapy is discouraged unless antibiotic sensitivity shows clarithromycin susceptibility due to increasing clarithromycin and levofloxacin resistance.
Testing and Follow-up:
Proof of H. pylori eradication is required post-treatment using fecal antigen, urea breath test, or gastric biopsy.
Testing should occur at least 4 weeks after antibiotics and 2 weeks after stopping PPIs/PCABs, with H2 receptor antagonists or antacids allowed during the interim.
Expanded Indications:
Testing and treatment should be extended to individuals at increased risk for gastric cancer, those with atrophic gastritis, gastric intestinal metaplasia, or household members of those with H. pylori.
Conclusion: The guideline emphasizes evidence-based treatment regimens, eradication testing, and expanded testing to reduce gastric cancer risk, reflecting H. pylori's role as a Class I carcinogen by the WHO.
Bình luận