H Pylori Guideline Revision Supplement 2022

Reason[s] for update

Routine 2-year update.

Methods

• Review of latest ANMC H. pylori treatment guideline (Feb 19, 2020 , Archive)
  
• Updated literature search (PubMed, (alaska[Title] OR polar[Title] OR arctic[Title]) AND helicobacter[Title/Abstract]). This is a broader search than previously in that it looks for "helicobacter" in the abstract as well as the title.
• Attendance at the 2019 Combating Gastric Cancer in Alaska Native People: An Expert and Community Symposium

>Hosted by the CDC in Anchorage, Alaska

>Experts were longstanding, world-renown researchers

>Results were published in Gastroenterology in April 2020

Results

1. ANMC H. Pylori Treatment Guideline has no significant changes pertinent to the YKHC guideline. Of note, ANMC has started a study of offering EGD for gastric cancer screening for patients with a first-degree relative (parent, sibling, or child) with gastric cancer; they are treating to eradicate H. pylori in this group regardless of findings; but this treatment is limited to the study patients and thus is not applicable to our practice in Bethel.
2. PubMed search returned 49 articles. The only article published since the prior literature search (in 2017) to address treatment in our setting was the CDC conference summary, which continues to explicitly advocate the current algorithm/guideline.

Guideline Changes

1. Under treatment indications, "Intestinal Metaplasia" is changed to "Gastric Intestinal Metaplasia" (to prevent any confusion with Barrett's esophagus).
2. Addition of box specifying test of cure details.

Author: Andrew W. Swartz, MD

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