#초록#
Since the guidelines of the US National Institute of Health for Helicobacter pylori (H.
pylori) infection were produced in 1994, several recommendations for the management of
the infection have been developed independently in European and Asian Pacific countries.
However, those are not identical because prevalence rate of H. pylori infection, incidence
of gastric cancer, and regional economic status vary significantly in different localities.
Until recently, there have been considerable confusions over the management of H.
pylori infection. Therefore, it is urgent to develop our own consensus guidelines at the
moment. In February 1998, the Korean H. pylori Study Group organized a domestic
consensus meeting and has made recommendations based on available evidences
reported, after taking the mentioned regional characteristics into consideration. A number
of diagnostic tests for the infection are available throughout the country. When
endoscopy is clinically available, biopsy urease testing and histology are recommended
as the tests of choice. Serological test is not recommended at the moment because of its
low sensitivity and especially low specificity reported in Korea. The urea breath test is
more sensitive and specific noninvasive test than serological test, but it is not widely
available yet. All gastric and duodenal ulcer patients who are infected with H. pylori
should be treated for H. pylori regardless of the stage of ulcer (active, complicated or
scarring). Treatment is also recommended for the patients with endoscopic resection of
early gastric cancer (EGC) and for the patients with low-grade gastric
mucosa-associated lymphoid tissue (MALT) lymphoma, although supporting evidence is
limited. However, patients with family history of gastric cancer and patients with
non-ulcer dyspepsia, gastritis or duodenitis are not the subjects for eradication.
Asymptomatic persons and patients who want to be treated should not be tested and
treated, either. It was concluded that there wasn’t sufficient evidence that cure of H.
pylori infection reduces the risk of gastric adenocarcinoma or prevents the development
of it. Therefore, eradication of H. pylori should not be attempted for the purpose of
preventing development of gastric cancer. Post-treatment testing was not always
recommended for all patients. It is appropriate to confirm eradication and ulcer healing
in patients with gastric ulcer, complicated duodenal ulcer, gastric MALT lymphoma or
endoscopic resection of EGC. In patients with persistent symptoms or relapsing
symptoms should be followed with endoscopy. Tests to confirm eradication of H. pylori
should be delayed at least 4 weeks after completion of therapy. Serology is not useful to
confirm the eradication of H. pylori. If endoscopy is indicated after treatment, obtaining
multiple biopsy specimens from the gastric antrum, body and cardia is recommended for
both urease testing and histology. The urea breath test is the test of choice to confirm
eradication, if available. One or two weeks treatment of proton pump inhibitor (PPI)
based triple therapy consisting of one PPI and two antibiotics, clarithromycin and
amoxicillin, is recommended as the first line treatment regimen. Usage of metronidazole
is not recommended because of high prevalence of its resistance in Korea. In the case
of treatment failure, quadruple therapy (PPI+ classic bismuth triple) is recommended.
Screening all dyspeptic patients for H. pylori infection is not recommended. Even
dyspeptic patients who have been diagnosed as H. pylori-positive are not the candidates
for eradication treatment, either It is strongly recommended that dyspeptic patients over
30 years of age and those with alarm symptoms irrespective of age should be performed
endoscopy to rule out the possibility of gastric cancer in Korea.
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