Clinical Trials Study
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World J Gastroenterol. Aug 21, 2014; 20(31): 10969-10983
Published online Aug 21, 2014. doi: 10.3748/wjg.v20.i31.10969
Management of Helicobacter pylori infection in Latin America: A Delphi technique-based consensus
Antonio Rollan, Juan Pablo Arab, M Constanza Camargo, Roberto Candia, Paul Harris, Catterina Ferreccio, Charles S Rabkin, Juan Cristóbal Gana, Pablo Cortés, Rolando Herrero, Luisa Durán, Apolinaria García, Claudio Toledo, Alberto Espino, Nicole Lustig, Alberto Sarfatis, Catalina Figueroa, Javier Torres, Arnoldo Riquelme
Antonio Rollan, Pablo Cortés, Luisa Durán, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7650568, Chile
Juan Pablo Arab, Roberto Candia, Alberto Espino, Nicole Lustig, Alberto Sarfatis, Catalina Figueroa, Arnoldo Riquelme, Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
M Constanza Camargo, Charles S Rabkin, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20852, United States
Roberto Candia, Programa de Salud Basada en Evidencia, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
Paul Harris, Juan Cristóbal Gana, Departamento de Gastroenterología y Nutrición Pediátrica, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
Catterina Ferreccio, Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
Rolando Herrero, International Agency for Research on Cancer, World Health Organization, 69372 Lyon, France
Apolinaria García, Departamento de Microbiología, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción 4089100, Chile
Claudio Toledo, Unidad de Gastroenterología, Hospital de Valdivia. Facultad de Medicina, Universidad de Austral de Chile, Valdivia 5090000, Chile
Javier Torres, Unidad de Investigación en Enfermedades Infecciosas, Instituto Mexicano del Seguro Social, 06600 Ciudad de México, Mexico
Author contributions: Rollan A, Camargo MC, Candia R, Harris P, Ferreccio C, Torres J and Riquelme A designed the research; Arab JP, Candia R, Camargo MC, Harris P, Gana JC, Cortés P, Rabkin CS, Herrero R, Durán L, García A, Toledo C, Espino A, Lustig N, Sarfatis A and Figueroa C performed the research; Rollan A, Camargo MC, Harris P, Ferreccio C and Riquelme A wrote the paper.
Correspondence to: Antonio Rollan, MD, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Av. Vitacura 5951, Santiago 7650568, Chile. arollan@alemana.cl
Telephone: +56-2-25866032 Fax: +56-2-25866032
Received: January 14, 2014
Revised: March 21, 2014
Accepted: May 23, 2014
Published online: August 21, 2014
Processing time: 218 Days and 18.1 Hours
Abstract

AIM: To optimize diagnosis and treatment guidelines for this geographic region, a panel of gastroenterologists, epidemiologists, and basic scientists carried out a structured evaluation of available literature.

METHODS: Relevant questions were distributed among the experts, who generated draft statements for consideration by the entire panel. A modified three-round Delphi technique method was used to reach consensus. Critical input was also obtained from representatives of the concerned medical community. The quality of the evidence and level of recommendation supporting each statement was graded according to United States Preventive Services Task Force criteria.

RESULTS: A group of ten experts was established. The survey included 15 open-ended questions that were distributed among the experts, who assessed the articles associated with each question. The levels of agreement achieved by the panel were 50% in the first round, 73.3% in the second round and 100% in the third round. Main consensus recommendations included: (1) when available, urea breath and stool antigen test (HpSA) should be used for non-invasive diagnosis; (2) detect and eradicate Helicobacter pylori (H. pylori) in all gastroscopy patients to decrease risk of peptic ulcer disease, prevent o retard progression in patients with preneoplastic lesions, and to prevent recurrence in patients treated for gastric cancer; (3) further investigate implementation issues and health outcomes of H. pylori eradication for primary prevention of gastric cancer in high-risk populations; (4) prescribe standard 14-d triple therapy or sequential therapy for first-line treatment; (5) routinely assess eradication success post-treatment in clinical settings; and (6) select second- and third-line therapies according to antibiotic susceptibility testing.

CONCLUSION: These achievable steps toward better region-specific management can be expected to improve clinical health outcomes.

Keywords: Helicobacter pylori; Consensus development conference; Delphi technique; Latin America

Core tip: By means of Delphi technique method, a multidisciplinary panel of Latin American experts releases a set of updated recommendations on diagnosis and treatment of Helicobacter pylori (H. pylori) infection for this region. Main recommendations include test and treat all symptomatic patients submitted to gastroscopy, use 14-d triple therapy or sequential therapy for first-line treatment, and to promote more information and demonstration projects to identify effective and safe strategies for control and prevention in areas with high prevalence of H. pylori infection and associated diseases.