Helicobacter Pylori and Gastroduodenal Ulcer Disease
Helicobacter Pylori and Gastroduodenal Ulcer Disease
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DOI：
10.3238/arztebl.2009.0801
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发表时间：
2009-12-04
影响因子：
7.7
通讯作者：
Koletzko, S.
中科院分区：
文献类型：
--
作者：
Fischbach, W.;Malfertheiner, P.;Koletzko, S.
背景：幽门螺杆菌相关疾病和胃十二指肠溃疡疾病是具有重要临床和经济意义的常见疾病。因此，需要制定一项准则，其中应纳入近年来获得的科学知识，并考虑到德国在流行病学、耐药性状况、诊断评估和治疗方面的具体情况。本S3级共识指南是根据德国科学医学协会的建议制定的（Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften，AWMF）.它是受德国消化和代谢疾病协会（Deutsche Gesellschaft fur Verdauungs-und Stoffwechselkrankheiten，DGVS）委托，与其他科学协会合作编写的。编辑检索词后，在PubMed和科克伦数据库中进行系统的IT支持文献检索。检索仅限于2000年以后以德语或英语发表的文章。幽门螺杆菌感染可以通过非侵入性（用C-13-尿素呼气试验或粪便抗原试验）或侵入性（用快速尿素酶试验、通过组织学或通过培养）来准确诊断。胃和十二指肠溃疡以及胃MALT淋巴瘤是根除治疗的绝对适应症;相对适应症包括功能性消化不良、预防高危人群中的胃癌、开始使用非甾体抗炎药（NSAID）进行长期治疗以及既往使用NSAID或乙酰水杨酸（阿萨）发生胃十二指肠并发症。一线治疗包括质子泵抑制剂（PPI）和克拉霉素联合甲硝唑或阿莫西林，给予至少一周。结论：该指南使结构化的，循证的诊断和治疗H。幽门螺杆菌感染和相关病症，以及胃十二指肠溃疡疾病。
Background: Helicobacter pylori-associated diseases and gastroduodenal ulcer disease are common conditions of major clinical and economic importance. There is thus a need for a guideline that incorporates the scientific knowledge gained in recent years and that takes specific aspects of the situation in Germany into account with regard to epidemiology, resistance status, diagnostic evaluation, and treatment.Methods: This level-S3 consensus guideline was developed in accordance with the recommendations of the Association of Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF). It was commissioned by the German Association for Digestive and Metabolic Diseases (Deutsche Gesellschaft fur Verdauungs- und Stoffwechselkrankheiten, DGVS) and prepared in cooperation with other scientific societies. After search terms were compiled, a systematic, IT-supported literature search was performed in the PubMed and Cochrane databases. The search was restricted to articles that appeared in German or English from 2000 onward.Results: H. pylori infection can be accurately diagnosed either non-invasively (with a C-13-urea breath test or a stool antigen test) or invasively (with a rapid urease test, by histology, or by culture). Gastric and duodenal ulcer and gastric MALT lymphoma are absolute indications for eradication therapy; relative indications include functional dyspepsia, the prevention of gastric cancer in persons at risk, the initiation of long-term treatment with non-steroidal anti-inflammatory drugs (NSAID), and the prior occurrence of gastroduodenal complications with the use of either NSAID or acetylsalicylic acid (ASA). First-line therapy consists of a proton-pump inhibitor (PPI) and clarithromycin combined with either metronidazole or amoxicillin, given for at least one week.Conclusion: This guideline enables the structured, evidence-based diagnosis and treatment of H. pylori infection and associated conditions, as well as of gastroduodenal ulcer disease.