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Kyoto Global Consensus Report On Helicobacter Pylori Gastritis

Kyoto global consensus report on Helicobacter pylori gastritis

---Gut published online July 17,2015


Kentaro Sugano, Jan Tack, Ernst J Kuipers, David Y Graham, Emad M El-Omar, Soichiro Miura, Ken Haruma, Masahiro Asaka, Naomi Uemura, Peter Malfertheiner, on behalf of faculty members of Kyoto Global Consensus Conference


CQ6. Is H. pylori gastritis an infectious disease irrespective of symptom and complications? 

Statement 6 H. pylori gastritis should be defined as an infectious disease, even when patients have no symptoms and irrespective of complications such as peptic ulcers and gastric cancer. 

Grade of recommendation: strong 

Evidence level: high 

Consensus level: 100


CQ8. Should we categorise H. pylori-associated dyspepsia as a specific entity? 

Statement 8A In H. pylori-infected patients with dyspepsia, symptoms can be attributed to H. pylori gastritis if successful eradication therapy is followed by sustained symptom remission. 

Grade of recommendation: strong 

Evidence level: high 

Consensus level: 97.4% 


CQ16. When is it appropriate to search and screen for H. pylori gastritis? 

Statement 16 Depending on the epidemiological context, it is appropriate to search and screen for H. pylori gastritis at an age before development of atrophic gastritis and intestinal metaplasia. 

Grade of recommendation: strong 

Evidence level: moderate 

Consensus level: 97.3%


CQ17. Should all H. pylori-positive individuals receive eradication therapy? 

Statement 17 H. pylori infected individuals should be offered eradication therapy, unless there are competing considerations. 

Grade of recommendation: strong 

Evidence level: high 

Consensus level: 100%


CQ18. What is the optimal timing for H. pylori eradication in asymptomatic subjects? 

Statement 18 The maximum benefit of H. pylori eradication is obtained if it is done while the mucosal damage is still non-atrophic. 

Grade of recommendation: strong 

Evidence level: high 

Consensus level: 100%


CQ20. Does eradication of H. pylori prevent gastric cancer? 

Statement 20 Eradication of H. pylori reduces the risk of gastric cancer. The degree of risk reduction depends on the presence, severity and extent of atrophic damage at the time of eradication. 

Grade of recommendation: strong 

Evidence level: high 

Consensus level: 100%


CQ21. Should the outcome of eradication therapy always be assessed (ie, test for cure)

Statement 21 The outcome of eradication therapy should always be assessed, preferably non-invasively. 

Grade of recommendation: strong 

Evidence level: high 

Consensus level: 100%


Comment 

Failure of eradication is common and allows the mucosal damage to progress, and so eradication should always be confirmed,preferably using a non-invasive test such as a urea breath test or a validated monoclonal-based stool antigen test. For patients requiring endoscopic follow-up, such as after endoscopic removal of a gastric adenoma, histological assessment can be used. Confirmation of cure also provides an early warning system for the increasing antibiotic resistance in a population that will manifest as increasing rates of treatment failure.