Abstract
Helicobacter pylori infection is a major cause of peptic ulcer and is also associated with chronic gastritis, mucosa-associated lymphoid tissue (MALT) lymphoma, and adenocarcinoma of the stomach. Guidelines have been developed in the United States and Europe (areas with low prevalence) for the diagnosis and management of this infection, including the recommendation to 'test and treat' those with dyspepsia. A group of international experts performed a targeted literature review and formulated an expert opinion for evidenced-based benefits and harms for screening and treatment of H. pylori in high-prevalence countries. They concluded that in Arctic countries where H. pylori prevalence exceeds 60%, treatment of persons with H. pylori infection should be limited only to instances where there is strong evidence of direct benefit in reduction of morbidity and mortality, associated peptic ulcer disease and MALT lymphoma and that the test-and-treat strategy may not be beneficial for those with dyspepsia.
Highlights
Members of the committee performed a Medline targeted literature review using PubMed searching for the following topics: the prevalence of H. pylori in endemic regions, regional patterns of antimicrobial resistance, success/failure of eradication in persons with this infection living in endemic regions vs. low-prevalence regions, efficacy of treatment on outcomes
There will be a high probability of positive serology or other test when using the test-and-treat strategy in populations with high prevalence of H. pylori regardless of symptomatology
The test-and-treat strategy should not be utilized in populations with a high prevalence of H. pylori
Summary
Clinicians, public health experts and researchers with expertise in H. pylori infections in the Arctic and sub-Arctic met in Copenhagen in 2010 and 2011 and in Fairbanks, Alaska in 2012. Members of the committee performed a Medline targeted literature review using PubMed searching for the following topics: the prevalence of H. pylori in endemic regions, regional patterns of antimicrobial resistance, success/failure of eradication in persons with this infection living in endemic regions vs low-prevalence regions, efficacy of treatment on outcomes (peptic ulcer, dyspepsia, reduction in the incidence of gastric cancer, and reinfection rates in high-prevalence vs lowprevalence regions) In drafting these comments, the members of the committee gave weight to randomized control treatment trials and longitudinal cohort studies over cross-sectional studies. The experts defined an endemic region as an area where at least 60% of the population had a positive IgG test for H. pylori
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