Zdravniški Vestnik (Apr 2018)
A position statement of the Slovenian Association for Gastroenterology and Hepatology on the management of patients infected with Helicobacter pylori
Abstract
The article presents a position statement of the Slovenian Association for Gastroenterology and Hepatology on the management of patients infected with Helicobacter pylori (H. pylori). Position statement was presented and adopted at the 64th SAGH meetting on 11 November 2016 in Portorož. Every patient infected with H. pylori needs treatment. Recommended first-line regimen is a 14-day treatment with esomeprazole, amoxicillin and clarithromycin. The success of treatment must be monitored by non-invasive tests (urea breath test) one month or more after completing the treatment. When the first-line treatment fails, we recommend that patient is referred to a gastroenterologist. The recommended second-line therapy consists of a 14-day treatment with levofloxacin (esomeprazole, amoxicillin, levofloxacin), or 14 per day treatment with colloidal bismuth (esomeprazole, colloidal bismuth, oxytetracycline / amoxicillin, metronidazole). All third-line treatments should be based on the results of antibiotic susceptibility testing. H. pylori is grade I carcinogen and is responsible for 89 % of all cancers of the stomach, with the exception of cancer of the cardia. Therefore, the SAGH recommends that we should start with a national screening programme for H. pylori infection in asymptomatic Slovenian population aged between 20 and 30 years. All H. pylori infected patients should be treated with a 14-day quadruple regimen (esomeprazole, colloidal bismuth, oxytetracycline / amoxicillin, metronidazole). The program must be organised and supervised along the lines of the SVIT programme. Position statement is also given for secondary gastric cancer prevention in older patients with chronic H. pylori infection and diffuse preneoplastic gastric mucosa changes (atrophy and intestinal metaplasia).
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