2022中国幽门螺杆菌感染治疗指南  

2022 Chinese national clinical practice guideline on Helicobacter pylori eradication treatment

作　　者：中华医学会消化病学分会幽门螺杆菌学组 周丽雅[2] Helicobacter pylori Study Group,Chinese Society of Gastroenterology,Chinese Medical Association;Zhou Liya(不详;Department of Gastroenterology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]不详 [2]北京大学第三医院消化内科,北京100191

出　　处：《中华消化杂志》2022年第11期745-756,共12页Chinese Journal of Digestion

摘　　要：幽门螺杆菌感染是一种感染性疾病,全球感染率高达50%,其与消化不良、胃炎、消化性溃疡和胃癌的发生密切相关。根除幽门螺杆菌可有效控制相关疾病进展,降低相关疾病发生风险。然而,全球抗生素耐药率的升高使幽门螺杆菌感染根除效果面临巨大挑战。虽然幽门螺杆菌感染率在发达国家逐渐下降,但在发展中国家仍居高不下,造成了沉重的公共卫生负担。本指南的制定旨在为幽门螺杆菌感染的根除治疗提供指导。本临床实践指南按照世界卫生组织推荐的制定流程,采用国际公认的推荐等级的评估、制定与评价(GRADE)系统评估证据质量,并利用证据到决策框架制定临床推荐意见,既减小偏倚,又提高临床实践指南制定过程的透明性。使用国际实践指南报告规范(RIGHT)声明和临床指南研究与评价系统Ⅱ(AGREEⅡ)作为报告和行为指南,以确保其完整性和透明度。本临床实践指南包含12项关于幽门螺杆菌感染根除治疗的建议;值得强调的是,铋剂安全、有效、价格低廉,本临床实践指南推荐铋剂四联方案成为幽门螺杆菌感染根除治疗的首选。在幽门螺杆菌感染初次经验性根除治疗中,高剂量双联方案与铋剂四联方案疗效相当。本临床实践指南中的12项建议是在考虑患者的价值偏好、资源的可及性、根除方案可行性和可接受性的基础上形成,这些建议也适用于与中国具有相似抗生素耐药模式的地区,以及具有类似社会经济水平的国家。Helicobacter pylori(H.pylori)infection is an infectious disease with a prevalence rate of up to 50%worldwide.It can cause dyspepsia,gastritis,peptic ulcer disease and gastric cancer.H.pylorieradication treatment can effectively control disease progression and reduce risk of the conditions.However,the escalating trend of antibiotic resistance presents a global challenge for H.pylori eradication.Though decreasing in developed countries,the prevalence of H.pylori infection remains high in developing countries,causing a major public health burden.This clinical practice guideline(CPG)is made to provide guidance on the pharmacological treatment of H.pylori infection.This CPG is developed following the World Health Organization′s recommended process,adopting grading of recommendations assessment,development,and evaluation(GRADE)in assessing evidence quality and utilizing evidence to decision framework to formulate clinical recommendations,minimising bias and increasing transparency of the CPG development process.The Reporting Items for Practice Guidelines in Healthcare(RIGHT)statement and Appraisal of Guidelines for Research and EvaluationⅡ(AGREEⅡ)are used as reporting and conduct guide to ensure its completeness and transparency.This CPG contains 12 recommendations concerning pharmacological treatment for H.pylori eradication.Among them,it is worth highlighting that bismuth preparations are safe,effective and inexpensive,consequently making bismuth quadruple therapy a preferred choice for initial and rescue treatments.In empirical treatment,high dose dual therapy is equally effective as bismuth quadruple therapy.The 12 recommendations in this CPG are formed with consideration to stakeholders′values and preferences,resource use,feasibility and acceptability.These recommendations are generalisable to resource limited settings with similar antibiotic resistance pattern as China,and status with comparable sociological and technical challenges.

关 键 词：幽门螺杆菌 根除治疗 抗生素 指南 

分 类 号：R573.1[医药卫生—消化系统]