H. pylori with 50% prevalence requires active examination/tx

[Interview] Park Sun-jae, Director of Myongji Hospital in Busan

If intestinal metaplasia or atrophic gastritis is confirmed, non-benefit treatment is recommended

If having a family history of stomach cancer, pt needs to be actively examined and treated

Helicobacter pylori is a bacteria that causes digestive diseases such as acute gastritis, chronic gastritis, gastric ulcer, duodenal ulcer, gastric lymphoma, and gastric cancer, and is defined by the World Health Organization as a first-class carcinogen.

 

As half of the nation's population is evaluated as Helicobacter infections, the importance of eradication treatment is increasing in recent clinical sites.

 

On the 5th, Park Sun-jae, director of the Myongji Hospital in Busan, stressed the need for treatment, saying that the prevalence in Korea has decreased to around 50% due to the introduction of Helicobacter eradication treatment, but still maintains a high prevalence.

 

Helicobacter pylori is a spiral bacterium that can be activated even in the stomach, which is a strong acid environment.

 

It is known to induce chronic gastritis and intestinal epithelium, increasing the risk of gastric cancer by about 10 times.

 

Park Sun-jae, director of Myongji Hospital in Busan

In Korea, as benefits for all Helicobacter pylori treatments have been recognized since 2018, eradication treatments have also continued to expand their influence.

 

Specifically, health insurance benefits are applied to MALT lymphoma, peptic ulcers, early gastric cancer surgery (endoscopic resection), and idiopathic thrombocytopenia.

 

Iron deficiency anemia, functional dyspepsia, atrophic gastritis, intestinal metaplasia, gastric cancer family history, and other cases where eradication is evaluated as necessary due to medical judgment are being used in clinical sites as non-reimbursement.

 

Director Park said, "The criteria for primary treatment therapy have been expanded to the 2020 guidelines of the Society," adding, "However, patients who can be strongly recommended will be divided depending on whether they are diseases that meet the health insurance benefit standards." "If intestinal metaplasia or atrophic gastritis is clearly confirmed through endoscopy or if there is a family history of gastric cancer, it is recommended to patients regardless of whether health insurance benefits are applied or not." Currently, primary therapy is classified into four types according to the recommendation criteria of the 2020 Korean Upper Gastrointestinal and Helicobacter Society.

 

Conventional triple therapy (Amoxicillin + Clathromycin + PPI), quadruple therapy without Bismuth (Amoxicillin + Clathromycin + PPI + Metronidazole), triple therapy selection after Clathromycin resistance testing, and etc.

 

are recommended in some patients.

 

Director Park said, "As a first-line treatment, conventional triple therapy has changed OTC period from 7 days to 14 days.

 

In the case of the 7th, the success rate of treatment may decrease, he said.

 

"In fact, there are cases where 14 days fail due to the high resistance rate in Korea such as Clarithromycin." This varies depending on the region or the age group that uses a lot of antibiotics, she said.

 

She said, "Quadruple therapy is an additional Metronidazole-based drug, but depending on the patient, it is not a drug that the patient suffers when prescribed compared to the three-drug therapy on the 14th." She evaluated, "As a secondary treatment, it is not burdensome to feel in actual clinical trials rather than quadruple-drug therapy including Bismuth." Recently, P-CAB along with PPI has become possible for eradication treatment, but in terms of safety, existing treatments with accumulated clinical data are preferred, she explained.

 

Director Park said, "It varies from doctor to doctor.

 

If a specific item has a poor eradication rate, we do not change the treatment." Regarding PPI and P-CAB prescriptions, there is also a problem with drug prices, she said.

 

"As the number of prescriptions on the 14th increases as the primary treatment therapy, the difference in drug prices is greater." Although antibiotics are similar, the difference in drug prices of these ingredients can be a burden on patients.