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, 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
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: Consensus development conference; Delphi technique; Helicobacter pylori; Latin America.
Source: PubMed