H Pylori Guideline Revision Supplement 2022

This guideline revision page addresses only the methods and results of the 2022 guideline update. For a broader review of the topic of H. pylori in Alaska Natives and for prior and/or ANMC guidelines, see the Helicobacter pylori in Alaska Natives page.

Reason[s] for update

Routine review/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

• Pediatric H. pylori literature review:

>PUBMED, pylori[Title] AND (pediatric*[Title] OR child*[Title]) AND (review[Title] OR overview[Title] OR guideline*[Title])

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, 12 of which were published since the last literature review. Only one of these articles addresses treatment in our setting, which is the CDC conference summary, which continues to explicitly advocate the current algorithm/guideline (which was originally published by an international, circumpolar expert group in 2016)
3. Pediatric PubMed search returned 50 results, the most pertinent being the Joint ESPGHAN/NASPGHAN Guidelines for the Management of Helicobacter pylori in Children and Adolescents (Update 2016)

Discussion

• The YKHC H. pylori guideline continues to be consistent with the ANMC H. pylori guideline.
• For adults, the YKHC guideline is very different than the standard of care in the remainder of the U.S. which endorsed the "test-and-treat" strategy. The prevalence of H. pylori in the Alaska Native population is far too high for such a strategy.
• For pediatrics, the YKHC guideline (which treats pediatrics identical to adults) is consistent with national guidelines (i.e. NASPGHAN)
• The only minor issue with the YKHC guideline is that it does not address recent recommendations regarding new, commercially available, rapid H. pylori culture and sensitivities to guide initial antimicrobial choice.

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:

• ≥4wks after COMPLETION of treatment.
• Either urea breath test (UBT), stool antigen test, or endoscopic biopsy (if indicated for other reasons; using either pathology or CLO-test).
• Regardless of test, no antibiotics or bismuth for FOUR weeks prior.
• Regardless of test, no PPI for TWO weeks prior.

Topics for Exploration

Commercial (i.e. non-CDC) rapid H. pylori culture/sensitivities which can be used to guide antimicrobial therapy for primary treatment.

Author: Andrew W. Swartz, MD

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