Guidelines for the Management of Helicobacter pylori Infection in Japan: 2009 Revised Edition |
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Authors: | Masahiro Asaka Mototsugu Kato Shin-ichi Takahashi Yoshihiro Fukuda Toshiro Sugiyama Hiroyoshi Ota Naomi Uemura Kazunari Murakami Kiichi Satoh Kentaro Sugano |
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Affiliation: | Department of Gastroenterology, Hokkaido University Graduate School of Medicine;, Division of Endoscopy, Hokkaido University Hospital, Sapporo;, Department of Gastroenterology, Kyorin University School of Medicine, Mitaka;, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya;, Toyama University Graduate School of Medicine, Toyama;, Department of Biomedical Laboratory Sciences, School of Health Sciences, Shinshu University School of Medicine, Matsumoto;, Department of Endoscopy, International Medical Center of Japan, Tokyo;, Department of Gastroenterology, Oita University School of Medicine, Oita;, Division of Gastroenterology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan |
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Abstract: | Background: Over the past few years, the profile of Helicobacter pylori infection has changed in Japan. In particular, the relationship between H. pylori and gastric cancer has been demonstrated more clearly. Accordingly, the committee of the Japanese Society for Helicobacter Research has revised the guidelines for diagnosis and treatment of H. pylori infection in Japan. Materials and Methods: Four meetings of guidelines preparation committee were held from July 2007 to December 2008. In the new guidelines, recommendations for treatment have been classified into five grades according to the Minds Recommendation Grades, while the level of evidence has been classified into six grades. The Japanese national health insurance system was not taken into consideration when preparing these guidelines. Results: Helicobacter pylori eradication therapy achieved a Grade A recommendation, being useful for the treatment of gastric or duodenal ulcer, for the treatment and prevention of H. pylori -associated diseases such as gastric cancer, and for inhibiting the spread of H. pylori infection. Levels of evidence were determined for each disease associated with H. pylori infection. For the diagnosis of H. pylori infection, measurement of H. pylori antigen in the feces was added to the tests not requiring biopsy. One week of proton-pump inhibitor-based triple therapy (including amoxicillin and metronidazole) was recommended as second-line therapy after failure of first-line eradication therapy. Conclusion: The revised Japanese guidelines for H. pylori are based on scientific evidence and avoid the administrative restraints that applied to earlier versions . |
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Keywords: | Guideline H. pylori infection gastric cancer MALT lymphoma atrophic gastritis Japan |
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