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World J Clin Cases. Jul 6, 2022; 10(19): 6349-6359
Published online Jul 6, 2022. doi: 10.12998/wjcc.v10.i19.6349
Current guidelines for Helicobacter pylori treatment in East Asia 2022: Differences among China, Japan, and South Korea
Jun-Hyung Cho, So-Young Jin
Jun-Hyung Cho, Digestive Disease Center, Soonchunhyang University Hospital, Seoul 04401, South Korea
So-Young Jin, Department of Pathology, Soonchunhyang University Hospital, Seoul 04401, South Korea
Author contributions: Cho JH designed research; Cho JH and Jin SY performed research and literature review; Cho JH wrote the paper; Cho JH and Jin SY contributed critical revision and editing.
Supported by the Soonchunhyang University Research Fund, No. 10210061.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun-Hyung Cho, MD, PhD, Associate Professor, Digestive Disease Center, Soonchunhyang University Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul 04401, South Korea. chojhmd@naver.com
Received: January 13, 2022
Peer-review started: January 13, 2022
First decision: March 8, 2022
Revised: March 11, 2022
Accepted: May 8, 2022
Article in press: May 8, 2022
Published online: July 6, 2022
Processing time: 162 Days and 4.7 Hours
Abstract

Helicobacter pylori (H. pylori) infection is highly prevalent in East Asia. The overall seroprevalence rate of H. pylori infection is 44.2% in China, 37.6%-43.2% in Japan, and 51.0% in South Korea. H. pylori can cause peptic ulcer disease and gastric cancer. East Asian countries have high rates of gastric cancer (age-standardized incidence rate: 20-30 per 100000). The Kyoto global consensus report emphasized that H. pylori gastritis should be considered the main cause for the development of gastric cancer. H. pylori treatment guidelines in China, Japan, and South Korea have recently been revised according to data from each of those countries. However, emerging antibiotic resistance is an important barrier to H. pylori eradication. The recommended H. pylori treatment regimens differ among those three East Asian countries. In this review, recent guidelines and up-to-date research on H. pylori treatment regimens from China, Japan, and South Korea are discussed.

Keywords: Helicobacter pylori; Treatment; Antibiotic resistance; China; Japan; South Korea

Core Tip: Since 2000, the standard triple regimen containing clarithromycin (CAM) has been used as a legacy therapy to eradicate Helicobacter pylori (H. pylori). Resistance to CAM by H. pylori has increased to > 15% in East Asia. First-line eradication rates below 80% are strongly associated with CAM-resistant H. pylori strain emergence. H. pylori treatment guidelines in China, Japan, and South Korea were revised according to new data. In China, adding bismuth to H. pylori regimens was recommended as an empirical first-line treatment. In Japan, H. pylori treatment success increased when the potassium-competitive acid blocker (P-CAB) was introduced. In South Korea, tailored H. pylori eradication based on molecular testing for CAM resistance is used as the first-line treatment option. Dual therapy involving frequent administration of high-dose amoxicillin has shown good efficacy for H. pylori eradication in clinical trials. Furthermore, P-CABs, with their rapid and strong acid-suppressing activity, may contribute to successful H. pylori treatment in future.