( ASEAN, the Association of Southeast Asian Nations, with Malaysia, Indonesia, Thailand, the Philippines, Singapore, Brunei, Vietnam, Laos, Myanmar and Cambodia, is the main point of the Bangkok consensus report released last year, or may provide for the treatment of Helicobacter pylori infection. Some ideas. )

Helicobacter pylori (Hp) infection is constantly evolving, and experts in the field of digestion have been thinking about the best treatment strategy. Treatment of Hp infection in ASEAN countries: The Bangkok Consensus Conference brought together a team of key experts from the region to review and evaluate Hp infections in clinical terms, and to develop consensus statements, recommendations, and recommendations for clinical treatment of Hp infection in ASEAN countries. The ASEAN Consensus Conference was attended by 34 international experts from 10 ASEAN member countries and Japan, Taiwan and the United States.

The meeting focused on four topics:

(I) epidemiology and disease links;

(II) diagnostic methods;

(III) treatment opinions; 

(IV) follow-up after eradication.

Consensus statement

Statement 1: 1a: Hp infection increases the risk of dyspeptic symptoms. (Level of Evidence: High; Recommended Level: N/A); 1b: All patients with dyspepsia should be tested and treated for Hp infection. (Level of evidence: high; recommended level: strong)

Statement 2: Because the use of Hp infection and/or non-steroidal anti-inflammatory drugs (NSAIDs) is highly correlated with peptic ulcers, the primary treatment for peptic ulcers is to eradicate Hp and/or discontinue the use of NSAIDs. (Level of evidence: high; recommended level: strong)

Statement 3: The age-standardized incidence of gastric cancer in ASEAN countries is 3.0 to 23.7 per 100,000 person-years. In most countries of ASEAN, stomach cancer remains one of the top 10 causes of cancer deaths. Gastric mucosa-associated lymphoid tissue lymphoma (stomach MALT lymphoma) is very rare. (Level of evidence: high; recommended level: N/A)

Statement 4: Eradication of Hp can reduce the risk of gastric cancer, and family members of gastric cancer patients should be screened and treated for Hp. (Level of evidence: high; recommended level: strong)

Statement 5: Patients with gastric MALT lymphoma should be eradicated for Hp. (Level of evidence: high; recommended level: strong) 

Statement 6: 6a: Based on the social burden of the disease, it is cost-effective to conduct a community screening of Hp through non-invasive testing to prevent eradication of gastric cancer. (Level of evidence: high; recommended level: weak)

                   6b: Currently, in most ASEAN countries, screening for community gastric cancer by endoscopy is not feasible. (Level of Evidence: Medium; Recommended Level: Weak)

Statement 7: In ASEAN countries, the different outcomes of Hp infection are determined by the interaction between Hp virulence factors, host and environmental factors. (Level of evidence: high; recommended level: N/A)

Statement 8: All patients with precancerous lesions of gastric cancer should undergo Hp detection and treatment, and stratify the risk of gastric cancer. (Level of evidence: high; recommended rating: strong)

Hp diagnosis method

Statement 9: Diagnostic methods for Hp in the ASEAN region include: urea breath test, fecal antigen test (monoclonal) and locally validated rapid urease test (RUT)/histology. The choice of detection method depends on the patient’s preferences, availability, and cost. (Level of evidence: high; recommended level: strong) 

Statement 10: Biopsy-based Hp detection should be performed in patients undergoing gastroscopy. (Level of Evidence: Medium; Recommended Level: Strong)

Statement 11: Detection of Hp proton pump inhibitor (PPI) is discontinued for at least 2 weeks; antibiotics are discontinued for at least 4 weeks. (Level of evidence: high; recommended rating: strong)

Statement 12: When long-term PPI therapy is required, it is recommended to detect Hp in patients with gastroesophageal reflux disease (GERD). (Level of Evidence: Medium; Recommended Rating: Strong)

Statement 13: Patients requiring long-term treatment with NSAIDs should be tested and treated for Hp. (Level of evidence: high; recommended level: strong) 

Statement 14: In patients with peptic ulcer bleeding and negative Hp initial biopsy, infection should be reconfirmed by subsequent Hp testing. (Level of Evidence: Medium; Recommended Level: Strong)

Statement 15: The urea breath test is the best choice after eradication of Hp, and the fecal antigen test can be used as an alternative. Testing should be performed at least 4 weeks after the end of eradication therapy. If a gastroscope is used, a biopsy can be performed. (Level of evidence: high; recommended level: strong)

Statement 16: It is recommended that national health authorities in ASEAN countries reimburse Hp for diagnostic testing and treatment. (Level of evidence: low; recommended level: strong)