PDF(Sci-hub)
Abstract：
A global consensus meeting was held to review current evidence and knowledge gaps and propose collaborative studies on population-wide screening and eradication of Helicobacter pylori for prevention of gastric cancer (GC).
28 experts from 11 countries reviewed the evidence and modified the statements using the Delphi method, with consensus level predefined as ≥80% of agreement on each statement. The Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach was followed.
Consensus was reached in 26 statements. At an individual level, eradication of H. pylori reduces the risk of GC in asymptomatic subjects and is recommended unless there are competing considerations. In cohorts of vulnerable subjects (eg, first-degree relatives of patients with GC), a screen-and-treat strategy is also beneficial. H. pylori eradication in patients with early GC after curative endoscopic resection reduces the risk of metachronous cancer and calls for a re-examination on the hypothesis of \'the point of no return\'. At the general population level, the strategy of screen-and-treat for H. pylori infection is most cost-effective in young adults in regions with a high incidence of GC and is recommended preferably before the development of atrophic gastritis and intestinal metaplasia. However, such a strategy may still be effective in people aged over 50, and may be integrated or included into national healthcare priorities, such as colorectal cancer screening programmes, to optimise the resources. Reliable locally effective regimens based on the principles of antibiotic stewardship are recommended. Subjects at higher risk of GC, such as those with advanced gastric atrophy or intestinal metaplasia, should receive surveillance endoscopy after eradication of H. pylori.
Evidence supports the proposal that eradication therapy should be offered to all individuals infected with H. pylori. Vulnerable subjects should be tested, and treated if the test is positive. Mass screening and eradication of H. pylori should be considered in populations at higher risk of GC.
28 experts from 11 countries reviewed the evidence and modified the statements using the Delphi method, with consensus level predefined as ≥80% of agreement on each statement. The Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach was followed.
Consensus was reached in 26 statements. At an individual level, eradication of H. pylori reduces the risk of GC in asymptomatic subjects and is recommended unless there are competing considerations. In cohorts of vulnerable subjects (eg, first-degree relatives of patients with GC), a screen-and-treat strategy is also beneficial. H. pylori eradication in patients with early GC after curative endoscopic resection reduces the risk of metachronous cancer and calls for a re-examination on the hypothesis of \'the point of no return\'. At the general population level, the strategy of screen-and-treat for H. pylori infection is most cost-effective in young adults in regions with a high incidence of GC and is recommended preferably before the development of atrophic gastritis and intestinal metaplasia. However, such a strategy may still be effective in people aged over 50, and may be integrated or included into national healthcare priorities, such as colorectal cancer screening programmes, to optimise the resources. Reliable locally effective regimens based on the principles of antibiotic stewardship are recommended. Subjects at higher risk of GC, such as those with advanced gastric atrophy or intestinal metaplasia, should receive surveillance endoscopy after eradication of H. pylori.
Evidence supports the proposal that eradication therapy should be offered to all individuals infected with H. pylori. Vulnerable subjects should be tested, and treated if the test is positive. Mass screening and eradication of H. pylori should be considered in populations at higher risk of GC.
摘要：
举行了一次全球共识会议，以审查当前的证据和知识差距，并提出了关于全人群筛查和根除幽门螺杆菌以预防胃癌（GC）的合作研究。
来自11个国家的28名专家使用德尔菲法审查了证据并修改了陈述，共识水平预定义为≥80%的每个陈述的一致性。推荐评估的分级，遵循开发和评估（GRADE）方法。
在26项声明中达成了共识。在个人层面,根除幽门螺杆菌可降低无症状受试者患GC的风险，除非有竞争性考虑，否则建议根除幽门螺杆菌。在弱势受试者的队列中(例如，GC患者的一级亲属），屏幕和治疗策略也是有益的。根治性内镜切除术后早期GC患者根除幽门螺杆菌可降低异时性癌症的风险，并要求对“无回报点”的假设进行重新检查。在一般人口层面，筛查和治疗幽门螺杆菌感染的策略在GC高发地区的年轻成人中最具成本效益,推荐在萎缩性胃炎和肠上皮化生发生前进行.然而,这种策略可能对50岁以上的人仍然有效，并且可能被纳入或纳入国家医疗保健优先事项，如结直肠癌筛查计划，优化资源。建议使用基于抗生素管理原则的可靠的局部有效方案。GC风险较高的受试者，如晚期胃萎缩或肠上皮化生，根除幽门螺杆菌后应接受监督内镜检查。
有证据支持对所有感染幽门螺杆菌的个体提供根除治疗的建议。弱势群体应该接受测试，如果测试呈阳性，则进行治疗。在GC风险较高的人群中，应考虑大规模筛查和根除幽门螺杆菌。
来自11个国家的28名专家使用德尔菲法审查了证据并修改了陈述，共识水平预定义为≥80%的每个陈述的一致性。推荐评估的分级，遵循开发和评估（GRADE）方法。
在26项声明中达成了共识。在个人层面,根除幽门螺杆菌可降低无症状受试者患GC的风险，除非有竞争性考虑，否则建议根除幽门螺杆菌。在弱势受试者的队列中(例如，GC患者的一级亲属），屏幕和治疗策略也是有益的。根治性内镜切除术后早期GC患者根除幽门螺杆菌可降低异时性癌症的风险，并要求对“无回报点”的假设进行重新检查。在一般人口层面，筛查和治疗幽门螺杆菌感染的策略在GC高发地区的年轻成人中最具成本效益,推荐在萎缩性胃炎和肠上皮化生发生前进行.然而,这种策略可能对50岁以上的人仍然有效，并且可能被纳入或纳入国家医疗保健优先事项，如结直肠癌筛查计划，优化资源。建议使用基于抗生素管理原则的可靠的局部有效方案。GC风险较高的受试者，如晚期胃萎缩或肠上皮化生，根除幽门螺杆菌后应接受监督内镜检查。
有证据支持对所有感染幽门螺杆菌的个体提供根除治疗的建议。弱势群体应该接受测试，如果测试呈阳性，则进行治疗。在GC风险较高的人群中，应考虑大规模筛查和根除幽门螺杆菌。
