Helicobacter pylori and gastric cancer
Helicobacter pylori is a Class I carcinogen of gastric cancer and the culprit of many gastric diseases.According to conservative estimates of the World Gastrointestinal Organization (WGO),
At least half of the world's population is infected with Helicobacter pylori. China is the country with the largest number of Helicobacter pylori infections, with nearly 700 million people infected.In other words, three out of every five people around you have been infected with Helicobacter pylori.
Implement Hp screening and eradication plan
Since different periods of follow-up have different effects on reducing the risk of gastric cancer, the Taipei Global Consensus clearly states that if the gastric mucosa has entered the stage of atrophy or intestinal metaplasia, the intensity of follow-up should be strengthened to prevent the occurrence of dysplasia or intestinal gastric cancer.The benefit of Hp eradication for gastric cancer prevention in patients with advanced gastric atrophy or intestinal metaplasia is reduced. Therefore, it is recommended to implement Hp screening and eradication programs in the population to detect potential cancers in time.
Eliminate Hp and achieve three birds with one stone
The implementation of Hp screening and eradication of Hp can play the role of "three birds with one stone", that is, it can not only prevent gastric cancer, but also effectively prevent and treat Hp-related dyspepsia and peptic ulcer; eradication of Helicobacter pylori has a high cost- Benefit advantages are mainly reflected in three aspects:
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Eliminate or reduce the risk of stomach cancer
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Reduce the cost of treating related diseases such as indigestion
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Can reduce the risk of infection in the surrounding population
The gold standard method for Hp detection
The "gold standard" for Hp testing is the urea breath test
Urea Breath Test (UBT) is a non-invasive detection method that uses radionuclide-labeled urea to specifically detect Helicobacter pylori infection in the human body. It is accurate, specific, and quick, and its overall diagnosis coincidence rate can reach 95%. The above can be used as the "gold standard" for the detection of Helicobacter pylori, a non-invasive detection method commonly used in clinical practice, and can be used for the diagnosis and eradication of current Helicobacter pylori infection.
The "gold standard" of urea breath test is 14C-urea breath test-liquid scintillation method
14C-Urea Breath Test (UBT)-The liquid scintillation method is the "gold standard" method for the urea breath test. Since Marshall et al. founded 14C-UBT to detect Helicobacter pylori, 14C-labeled UBT has become the most important non-invasive detection method for the diagnosis of Helicobacter pylori infection for more than 20 years.The accuracy is as high as 94.6%, and the repeatability is >94%.
UBT testing reagents quality control dosage
The higher the dose of 13C-urea, the higher the accuracy of 13C-UBT detection, but the corresponding cost will increase. The average sensitivity and specificity of the 75 mg dose are both over 97%, and its high enough accuracy makes it more clinically recommended by domestic experts.
The content of the drug 13C-urea taken during the test will directly affect the accuracy of the test.Studies have shown that: 75mg is used for adults, adolescents and children; 50mg will reduce reagent cost and sensitivity by half; 45mg dose is only used for children 2-11 years old;
13C and 14C detection accuracy is consistent
UBT has been used for about 30 years and is still the most common non-invasive test for diagnosing Hp infection. In 2015, World Joyrnal of Gastroenterology published a meta-analysis study: urea [13C] and urea [14C] breath test have the same accuracy.
Quadruple Therapy for Hp Eradication
Those who meet the indications for eradication are recommended to receive treatment. Quadruple therapy is recommended. Four drugs are taken orally at the same time. The course of treatment is 10-14 days, and the cure rate can reach about 90%.
Quadruple therapy: proton pump inhibitor (PPI) + antibiotic 1 + antibiotic 2 + bismuth
Except that the levofloxacin-containing regimen is not used as the initial treatment regimen, the eradication regimen is not divided into first-line and second-line, and the high-efficiency regimen should be used for the initial treatment as much as possible. After the initial treatment fails, one of the other options can be selected for salvage treatment.The choice of the plan should be based on the local Hp antibiotic resistance rate and personal drug use history, weighing the efficacy, drug costs, adverse reactions and their availability.
Concluding remarks
For gastric cancer high-incidence areas and high-risk groups of gastric cancer, screening and treatment of Hp infection is the most cost-effective strategy to prevent gastric cancer. It is also recommended to screen and eradicate Hp before the occurrence of atrophic gastritis and intestinal metaplasia. and The urea breath test is one of the preferred methods for large-scale screening.
The Taipei Global Consensus, based on clinical practice and evidence-based medicine, is expected to reduce the spread of Hp in my country, increase public awareness of Hp infection, reduce the occurrence of related diseases or gastric cancer, improve national health, and reduce the burden of health and economics. To a positive and important role, it is worthy of further promotion.
