Published online Aug 21, 2014. doi: 10.3748/wjg.v20.i31.10969
Revised: March 21, 2014
Accepted: May 23, 2014
Published online: August 21, 2014
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.
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.