Journal of Gastroenterology

, Volume 37, Supplement 13, pp 34–38 | Cite as

Indications forHelicobacter pylori eradication therapy and firstline therapy regimen in Japan: recommendation by the Japanese Society forHelicobacter Research

  • Kiichi Satoh
Article

Abstract

In November 2000, eradication therapy forHelicobacter pylori infection was approved under the present Japanese system of health insurance. Before the approval, the Japanese guideline of “Diagnosis and Treatment ofH. pylori infection” was made by the guideline committee of the Japanese Society forHelicobacter Research. Indications forH. pylori eradication therapy were classified into three groups: (A) recommended: gastric and duodenal ulcers; (B) recommended and managed at a specialized institution: low-grade gastric mucosa-associated lymphoid tissue lymphoma; (C) current studies of the significance of the therapy: following endoscopic mucosal resection of early gastric cancer and gastric surgery for gastric cancers, hyperplastic gastric polyp, atrophic gastritis, and nonulcer dyspepsia. The first-line therapy regimen recommended is 1 week of triple therapy with a proton pump inhibitor standard dose twice a day, amoxicillin 750mg bid, and clarithromycin 200 or 400mg bid. The reasons for preferring this regimen are to avoid extensive use of metronidazole, which is allowed for treatment ofTrichomonas infection in Japan, and the low rate of emergence of clarithromycin-resistantH. pylori with amoxicillin co-therapy. For second-line therapy patients should be referred to specialists, who can examine the susceptibility ofH. pylori isolates against antibiotics and have much experience with this therapy.

Key words

Helicobacter pylori eradication guideline 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    EuropeanHelicobacter pylori Study Group (EHPSG). Current European concepts in the management ofHelicobacter pylori infection: the Maastricht consensus report. Gut 1997;41:8–13.Google Scholar
  2. 2.
    Peura DA. The report of the Digestive Health Initiative international update conference onHelicobacter pylori. Gastroenterology 1997;113:S4–8.Google Scholar
  3. 3.
    Lam SK, Talley NJ. Report of the 1997 Asia Pacific consensus conference on the management ofHelicobacter pylori infection. J Gastroenterol Hepatol 1998;13:1–12.PubMedCrossRefGoogle Scholar
  4. 4.
    Asaka M, Sugano K, Sugiyama T, Takahashi S, Fukuda Y, Ota H, et al. Guideline of diagnosis and treatment ofH. pylori infection (in Japanese). Jpn JHelicobacter Res 2000;2(suppl 1):2–12.Google Scholar
  5. 5.
    Hopkins RJ, Girardi LS, Turney EA. Relationship betweenHelicobacter pylori eradication and reduced duodenal and gastric ulcer recurrence: a review. Gastroenterology 1996;110:1244–52.PubMedCrossRefGoogle Scholar
  6. 6.
    Kimura K, Asaka M, Toyota T, Satoh K, Kuwayama H, Sakaki N, et al. Phase 2 trial of dual therapy with lansoprazole and amoxicillin forHelicobacter pylori infection: multicenter trial in Japan (in Japanese). In: Abstracts of the 4th annual meeting of Japanese Society forHelicobacter research, June 1998, Sapporo, p. 73 (abstract).Google Scholar
  7. 7.
    Chan FKL, Sung JJY, Chung SCS, To KF, Yung MY, Leung VKS, et al. Randomised trial of eradication ofHelicobacter pylori before non-steroidal anti-inflammatory drug therapy to prevent peptic ulcers. Lancet 1997;350:975–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Hawkey CJ, Tulassay Z, Szczepanski L, van Rensburg CJ, Filipowicz-Sosnowska A, Lanas A, et al. Randomised controlled trial ofHelicobacter pylori eradication in patients on nonsteroidal anti-inflammatory drugs; HELP NSAIDs study. Lancet 1997;352:1016–21.CrossRefGoogle Scholar
  9. 9.
    Wotherspoon AC, Doglioni C, Diss TC, Pan L, Moschini A, de Boni M, et al. Regression of primary low-grade B-cell gastric lymphoma of mucosa-associated lymphoid tissue type after eradication ofHelicobacter pylori. Lancet 1993;342:575–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Stolte M, Edit S. Healing gastric MALT lymphomas by eradicatingHelicobacter pylori. Lancet 1993;342:568.PubMedCrossRefGoogle Scholar
  11. 11.
    Montalban C, Manzanal A, Boixeda D, Redondo C, Bellas C. Treatment of low grade gastric MALT lymphoma withHelicobacter pylori eradication. Lancet 1995;345:798–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Bayerdöeffer E, Neubauer A, Rudolph B, Thiede C, Lehn N, Edit S, et al. Regression of primary gastric lymphoma of mucosaassociated lymphoid tissue type after cure ofHelicobacter pylori infection. Lancet 1995;345:1591–4.CrossRefGoogle Scholar
  13. 13.
    Cammarota G, Tursi A, Montalto M, Papa A, Branca G, Vecchio FM, et al. Prevention and treatment of low-grade B-cell primary gastric lymphoma by anti-H.pylori therapy. J Clin Gastroenterol 1995;21:118–22.PubMedCrossRefGoogle Scholar
  14. 14.
    Uemura N, Mukai T, Okamoto S, Yamaguchi S, Mashiba H, Taniyama K, et al. Effect ofHelicobacter pylori eradication on subsequent development of cancer after endoscopic resection of early gastric cancer. Cancer Epidemiol Biomarkers Prev 1997;6: 639–42.PubMedGoogle Scholar
  15. 15.
    Ohkusa T, Takashimizu I, Fujiki K, Suzuki S, Shimoi K, Horiuchi T, et al. Disappearance of hyperplastic polyps in the stomach after eradication ofHelicobacter pylori: a randomized, controlled trial. Ann Intern Med 1998;129:712–5.PubMedGoogle Scholar
  16. 16.
    Sugano K, Satoh K, Kihira K, Okamoto S, Sasaki N, Taniyama K, et al. Regression of gastric adenomas by eradication ofHelicobacter pylori. Gastroenterology 1999;116:A511 (abstract).CrossRefGoogle Scholar
  17. 17.
    Annibale B, Marignani M, Azzoni C, D’Ambra G, Caruana P, D’Adda T, et al. Atrophic body gastritis: distinct features associated withHelicobacter pylori infection. Helicobacter 1997;2: 57–64.PubMedCrossRefGoogle Scholar
  18. 18.
    Tucci A, Poli L, Tosetti C, Biasco G, Grigioni W, Varoli O, et al. Reversal of fundic atrophy after eradication ofHelicobacter pylori. Am J Gastroenterol 1998;93:1425–31.PubMedCrossRefGoogle Scholar
  19. 19.
    Van der Hulst RWM, ten Kate FJW, Rauws EAJ, van der Ende A, Köycü B, Tyssen JGP, et al. The relation of CagA and the long-term sequelae of gastritis after successful cure ofH. pylori infection: a long-term follow-up study. Gastroenterology 1998; 114:A318–19 (abstract).CrossRefGoogle Scholar
  20. 20.
    Witteman EM, Mravunac M, Becx MJCM, Hopman WPM, Verschoor JSC, Tytgat GNJ, et al. Improvement of gastric inflammation and resolution of epithelial damage one year after eradication ofHelicobacter pylori. J Clin Pathol 1995;48:250–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Forbes GM, Warren JR, Glaser ME, Cullen DJ, Marshall BJ, Collins BJ. Long-term follow-up of gastric histology afterHelicobacter pylori eradication. J Gastroenterol Hepatol 1996;11: 670–3.PubMedCrossRefGoogle Scholar
  22. 22.
    Iijima K, Ohara S, Sekine H, Koike T, Kubota Y, Kato K, et al. Recovery of gastric acid secretion and mucosal atrophy afterH. pylori eradication in severe atrophie gastritis. Gastroenterology 1998;114:A156–7 (abstract).CrossRefGoogle Scholar
  23. 23.
    Sato R, Fujioka T, Murakami K, Kodama M, Kubota T, Nasu M. Cure ofHelicobacter pylori infection improves gastric atrophy: evaluation by five sites biopsy recommended in the updated Sydney system. Gastroenterology 1999;116:A301 (abstract).CrossRefGoogle Scholar
  24. 24.
    Haruma K, Mihara M, Okamoto E, Kusunoki H, Hananoki M, Tanaka S, et al. Eradication ofHelicobacter pylori increases gastric acidity in patients with atrophie gastritis of the corpus: evaluation of 24-h pH monitoring. Aliment Pharmacol Ther 1999;13:155–62.PubMedCrossRefGoogle Scholar
  25. 25.
    Satoh K, Kimura K, Takimoto T, Kihira K. A follow-up study of atrophic gastritis and intestinal metaplasia after eradication ofHelicobacter pylori. Helicobacter 1998;3:236–40.PubMedGoogle Scholar
  26. 26.
    McColl K, Murray L, El-Omar E, Dickson A, El-Nujumi A, Wirz A, et al. Symptomatic benefit from eradicatingHelicobacter pylori infection in patients with nonulcer dyspepsia. N Engl J Med 1998;339:1869–74.PubMedCrossRefGoogle Scholar
  27. 27.
    Blum AL, Talley NJ, O’Moráin C, van Zanten SV, Labenz J, Stolte M, et al. Lack of effect of treatingHelicobacter pylori infection in patients with nonulcer dyspepsia. N Engl J Med 1998;339:1875–81.PubMedCrossRefGoogle Scholar
  28. 28.
    Talley NJ, Janssens J, Lauritsen K, Rácz I, Bolling-Sternevald E. Eradication ofHelicobacter pylori in functional dyspepsia: randomized double blind placebo controlled trial with 12 months’ follow up. BMJ 1999;318:833–7.PubMedGoogle Scholar
  29. 29.
    Talley NJ, Vakil N, Ballard ED, Fennerty MB. Absence of benefit of eradicatingHelicobacter pylori in patients with nonulcer dyspepsia. N Engl J Med 1999;341:1106–11.PubMedCrossRefGoogle Scholar
  30. 30.
    Miwa H, Hirai S, Nagahara A, Murai T, Nishira T, Kikuchi S, et al. Cure ofHelicobacter pylori infection does not improve symptoms in nonulcer dyspepsia patients: a double-blind placebocontrolled study. Aliment Pharmacol Ther 2000;14:317–24.PubMedCrossRefGoogle Scholar
  31. 31.
    Asaka M, Sugiyama T, Satoh K, Kuwayama H, Fukuda Y, Fujioka T, et al. Phase 3 double-blind trial ofHelicobacter pylori eradication therapy with lansoprazole, amoxicillin and clarithromycin for patients with peptic ulcer disease (in Japanese). In: Abstracts of the 6th annual meeting of Japanese Society forHelicobacter research, June 2000, Tokyo, p. 90 (abstract).Google Scholar
  32. 32.
    Miwa H, Ohkusa R, Murai T, Nagahara A, Yamada T, Ogihara T, et al. Effectiveness of omeprazole-amoxicillin-clarithromycin (OAC) therapy forHelicobacter pylori infection in a Japanese population. Helicobacter 1998;3:132–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Miwa H, Nagahara A, Sato K, Ohkura R, Murai T, Shimizu H, et al. Efficacy of 1 week omeprazole or lansoprazole-amoxycillinclarithromycin therapy forHelicobacter pylori infection in the Japanese population. J Gastroenterol Hepatol 1999;14:317–21.PubMedCrossRefGoogle Scholar
  34. 34.
    Miwa H, Okura R, Murai T, Sato K, Nagahara A, Hirai S, et al. Impact of rabeprazole, a new proton pump inhibitor, in triple therapy forHelicobacter pylori infection. Aliment Pharmacol Ther 1999;13:741–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Suzuki J, Mine T, Kobayasi I, Fujita T. Assessment of a new triple agent regimen for the eradication ofHelicobacter pylori and the nature ofH. pylori resistance to this therapy in Japan. Helicobacter 1998;3:59–63.PubMedCrossRefGoogle Scholar
  36. 36.
    Houben MHMG, van de Beek D, Hensen EF, de Craen AJM, Rauws EAJ, Tytgat GNJ. A systematic review ofHelicobacter pylori eradication therapy: the impact of antimicrobial resistance on eradication rates. Aliment Pharmacol Ther 1999;13:1047–55.PubMedCrossRefGoogle Scholar
  37. 37.
    Murakami K, Fujioka T. Eradication therapy forHelicobacter pylori infection and drug resistance in Japan (in Japanese). Helicobacter Res 1998;2:423–8.Google Scholar
  38. 38.
    Lind T, Mégraud F, Unge P, Baterdörffer E, O’Morain C, Spiller R, et al. The MACH2 study: role of omeprazole in eradication ofHelicobacter pylori with 1-week triple therapies. Gastroenterology 1999;116:248–53.PubMedCrossRefGoogle Scholar
  39. 39.
    Laine L, Suchower L, Franz J, Connors A, Neil G. Low rate of emergence of clarithromycin-resistantHelicobacter pylori with amoxycillin co-therapy. Aliment Pharmacol Ther 1998;12:887–92.PubMedCrossRefGoogle Scholar
  40. 40.
    Hoshiya S, Watanabe K, Tokunaga K, Tanaka A, Ninomiya H, Shingaki M, et al. Relationship between eradication therapy and clarithromycin-resistantHelicobacter pylori. J Gastroenterol 2000;35:10–4.PubMedGoogle Scholar
  41. 41.
    Asaka M, Fujioka T. Panel discussion: problems after eradication ofHelicobacter pylori (in Japanese). Nippon Shokakibyo Gakkai Zasshi (Jpn J Gastroenterol) 1998;95(suppl):137–40 (abstract).Google Scholar
  42. 42.
    Hamada H, Haruma K, Mihara M, Kamada T, Yoshihara M, Sumii K, et al. High incidence of reflux oesophagitis after eradication therapy forHelicobacter pylori: impacts of hiatal hernia and corpus gastritis. Aliment Pharmacol Ther 2000;14:729–35.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2002

Authors and Affiliations

  • Kiichi Satoh
    • 1
  1. 1.Department of GastroenterologyJichi Medical SchoolTochigiJapan

Personalised recommendations