Cpg for dyspepsia and helicobacter pylori 2010

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  • (Dyspepsia)

    (Helicobacter pylori)

    Thailand Consensus for the management of Dyspepsia

    and Helicobacter pylori 2010

  • (Dyspepsia)

    (Helicobacter pylori)

    1 2553

    : . : . : . : .

    : ... : . : . : .

    :

    3/3 49 10110 0-2258-7954 0-22587954E-mail: [email protected]

  • : Dyspepsia Helicobacter pylori

    (dyspepsia) (Helicobacter pylori) Dyspepsia Helicobacter pylori .. 2542 10 dys-pepsia Functional dyspepsia Helicobacter pylori (Dyspep-sia) (Helicobacter pylori) 2

    (Dyspepsia) (Helicobacter pylori) .. 2553

    ..

    i

  • : Dyspepsia Helicobacter pylori

    ...................................................................................................................... i

    ..................................................................... 1

    (Consensus statements) ................... 3 .................................................. 15

    Thailand Consensus for the managementof Dyspepsia and Helicobacter pylori 2010 .................................. 20

    Thailand Consensus for the managementof Dyspepsia and Helicobacter pylori 2010 .................................. 23

    ii

  • : Dyspepsia Helicobacter pylori

    11-13 .. 2553 23 14 6 2 1

    4 2 dyspepsia Helicobacter pylori 2 2542 2 (level of evidence) (grade of recommendation) ( 1)

    1

  • : Dyspepsia Helicobacter pylori

    (Type of studies)

    - Systematic review of randomizedcontrolled trials (RCTs) of goodmethodological quality

    - Individual RCT- Comparative non-controlled studies- Systematic review of cohort stud-

    ies or case-control studies- Individual cohort studies/ Non-con-

    trolled cohort studies- Individual case-control studies- Case series- Poor quality cohort or case-control

    studies- Expert opinions- Clinical experiences of respected

    authorities

    1 (level of evidence) (grade of recommendation) (Dyspepsia) (Helicobacter pylori) ..2553

    (Grade of

    recommendation)1

    2

    3

    4

    (Level of evidence)1

    2

    3

    4

    2

  • : Dyspepsia Helicobacter pylori

    (Dyspepsia) Dyspepsia

    dyspepsia (heartburn) heartburn dyspepsia heartburn (Gastroesophageal reflux disease; GERD)

    Dyspepsia ROME III (Gastroduodenum)

    . (Epigastric pain) sternum mid clavicular line2 (Epigastrium)

    . (Epigastric burning) epi-gastrium (Burning)

    . (Post-prandial fullness)

    . (Early satiation)

    (Dyspepsia)

    3

  • : Dyspepsia Helicobacter pylori

    dyspepsia (Heartburn) (Acidregurgitation) ..2547

    dyspepsia (Algorithm)

    4

  • : Dyspepsia Helicobacter pylori

    (Consensus statements)

    1 dyspepsia

    (Uninvestigated dyspepsia) (Esophagogastroduodenoscopy, EGD)

    : 2 : 2

    18 dyspepsia (Uninvestigated dyspepsia) 2 dyspepsia dyspepsia

    2 (Alarm symptoms) dyspepsia

    1. (Dysphagia)2. (Evidence of gastrointestinal blood loss)

    melena 3. (Unexplained weight loss)

    4. (Persistent vomiting)

    5

  • : Dyspepsia Helicobacter pylori

    2

    dyspepsia : 3 : 3

    dyspepsia 3 dys-pepsia dyspepsia dyspepsia dyspepsia

    dyspepsia dyspepsia

    3 dyspepsia

    NSAIDs (ASA) penicillin, sulphonamides, macrolides, doxycycline, tetracycline

    , (Oral anti-diabetics),

    digoxin, calcium channel blockers (potassium supplement) alendronate theophylline

    6

  • : Dyspepsia Helicobacter pylori

    3 dyspepsia 55

    (EGD)

    : 3 : 3

    dyspepsia (new onset dyspepsia) dyspepsia dyspepsia 45 55 55

    4 dyspepsia 55

    : 3 : 3

    dyspepsia dyspepsia dyspep-sia

    7

  • : Dyspepsia Helicobacter pylori

    1.

    2. 3.

    4. 5. 2-3

    6. 20-40 3-5

    5 dyspepsia

    dyspepsia

    : 1 : 1

    uninvestigated dyspepsia (H. pylori) urea breath test (empirical acid suppressive therapy) 6 1 dyspepsia

    8

  • : Dyspepsia Helicobacter pylori

    6 (EGD)

    dyspepsia

    : 4 : 4

    EGD uninvestigated dyspepsia 55 duodenum 80% functional dyspep-sia dyspepsia

    7

    (ureabreath test)

    : 1 : 1

    H. pylori urea breath test(UBT) serology office-based labo-

    9

  • : Dyspepsia Helicobacter pylori

    ratory-based H. pylori serology

    false negative UBT PPI 14 antibiotics 28 H2-blockers 7 antacids

    UBT uninvestigated dyspepsia empirical acid suppressive therapy empiricaltreatment algorithm

    8 prokinetics

    dyspepsia (empirical treatment)

    : 1 : 1

    55 dyspepsia uncomplicated dyspepsia dyspepsia (empirical treatment) prokinetics (epi-gastric pain) (epigastric burning) prokinetics (post-prandial fullness) (early satiation) 2-4

    10

  • : Dyspepsia Helicobacter pylori

    prokinetics

    prokinetics prokinetics uninvestigated dyspepsia

    9

    (Step-up) 6 (Step-down)

    : 1 : 1

    (primary care) uninvestigated dyspepsia step-up acid suppressive therapy alum milk histamine-2 receptor antagonist (H2 antago-nist) proton pump inhibitor (PPI) standard dose step-down step-up 6 70 step-up

    dyspepsia heartburn reflux (reflux pre-dominant) step-down step-up ( ) GERD

    11

  • : Dyspepsia Helicobacter pylori

    10 dyspepsia

    (EGD)

    : 3 : 3

    empirical treatment

    11 prokinetics

    functional dyspepsia

    : 1 : 1

    prokinetics functional dyspepsia 50 dyspepsia ( prokinetics)

    12

  • : Dyspepsia Helicobacter pylori 13

    12 antidepressant functional

    dyspepsia tricyclics,tetracyclics selective serotonin reuptake inhibitor (SSRI) antidepressant prokinetics

    : 3 : 3

    antidepressants functionaldyspepsia 40 tricyclics antidepressant amitryptyline deanxit flupentixol neuroleptic melitracen tricyclic antidepressant amitryptyline prokinetics tetracyclic mirtazapine SSRI fluoxetine mianserin

    functional dyspepsia / prokinetics / antidepressants

  • : Dyspepsia Helicobacter pylori

    13 functional dyspepsia

    dyspepsia 14-18 1 functional dys-pepsia

    : 1 : 1

    H. pylori functional dyspepsia dyspepsia number needed to treat H. pylori 14-18 1 H. pylori dyspepsia

    14

  • : Dyspepsia Helicobacter pylori

    H. pylori

    14 dyspepsia

    ( 1 1)

    Atrophic gastritis 2 2Hemorrhagic / erosive gastritis 2 2MALToma 1 1After gastric cancer resection 2 2

    2 2

    (Helicobacter pylori)

    15

  • : Dyspepsia Helicobacter pylori

    2 2

    NSAIDs 1 1 2 2 (

    4 4)

    H. pylori (Gastric biopsies) rapid urease test rapidurease test ( ) rapid urease test

    15 PPI-based triple therapy

    : 2 : 2

    2-3 PPI-based tripletherapy PPI amoxycillin clarithromycin 7-10 69 clarithromycin 100

    16

  • : Dyspepsia Helicobacter pylori

    meta-analysis 14 10 7 PPI-based tripletherapy 7-14 80

    PPI-based triple therapy 4

    17

    PPI-based triple therapy PPI bid + amoxicillin 1 g bid + clarithromycin 500 mg bid PPI bid + metronidazole 400 mg bid + clarithromycin 500 mg bid PPI bid + amoxicillin 1 g bid + metronidazole 400 mg bid

    Bismuth-based quadruple therapy PPI bid + bismuth 240-525 mg bid + metronidazole 400 mg bid or

    tid + tetracycline 500 mg qid PPI bid + bismuth 240-525 mg bid + metronidazole 400 mg bid or

    tid + clarithromycin 500 mg bidSequential therapy

    PPI bid + amoxicillin 1 g bid 5 PPI bid + metronidazole 400-500 mg bid + clarithromycin 1000 mgod 500 mg bid 5

    Levofloxacin-based triple therapy PPI bid + levofloxacin 250 mg (or 500 mg) bid + amoxicillin 1 g bid

    Rifabutin-based triple therapy: 7-10 days PPI bid + rifabutin 150 mg bid + amoxicillin 1 g bid

    Concomitant therapy PPI bid + amoxicillin 1 g bid + clarithromycin 500 mg bid + metron-

    idazole 400 mg tid

    4 H. pylori

    7-14

    14

    10

    10

    10

    10

  • : Dyspepsia Helicobacter pylori

    16 sequential therapy

    90

    : 2 : 2

    clarithromycin sequen-tial 5 PPI amoxicillin PPI metron-idazole clarithromycin 5 10 ( 4) 5 clarithromycin metronida-zole amoxicillin penicillin

    PPI (standard dose) + amoxicillin1 gm 2 5 PPI (standard dose) bid + metron-idazole 500 mg bid + clarithromycin 1000 mg od 5 115 95 clarithromycin 6.1 PPI-based triple therapy sequential therapy PPI-based triple therapy sequential H. pylori PPI-based triple therapy 80

    17 4 (bismuth-

    based quadruple therapy) 14 PPI-based triple therapy amoxicillin

    : 2 : 2

    18

  • : Dyspepsia Helicobacter pylori

    18 PPI-based triple therapy

    sequential therapy 4 (bis-muth-based quadruple therapy) 14 3 levofloxacin rifabutin 10 3 PPI 1 (Concomitant therapy) 10

    : 2 : 2

    H. pylori

    19 (gastric ulcer)

    (complicated duodenal ulcer) (urea breath test) rapid urease test (histology)

    : 4