The first white paper on the prevention and control of "Helicobacter pylori" was released, delineating high-risk groups that must be eradicated

Interviewee: Xue Yan, chief physician of the Department of Gastroenterology, Peking University Third Hospital

Global Times health client reporter Guo Shiying

On June 3, the first white paper on the prevention and control of Helicobacter pylori infection in China (hereinafter referred to as the white paper) was officially released in Beijing. The white paper is jointly initiated by the China Primary Health Care Foundation and the Institute of Infectious Disease Prevention and Control of the Chinese Center for Disease Control and Prevention, led by the Helicobacter pylori infection prevention and control team led by Zhang Jianzhong, a researcher of the Institute of Infectious Disease Prevention and Control of the Chinese Center for Disease Control and Prevention, and organized relevant clinical, basic, oncology, chronic disease and public health experts across the country to jointly complete, and is the first manual for the diagnosis and treatment of Helicobacter pylori infection with Chinese characteristics in China.

Fifty percent of Chinese people have Helicobacter pylori infection

The white paper points out that the global infection rate of Helicobacter pylori is about 50% (18.9%~87.7%), and the infection rate of Helicobacter pylori varies greatly in different regions and different populations. In mainland China, the infection rate of Helicobacter pylori is nearly 50%, and the infection rate of different groups is 35.4%~66.4%; Rural infection rates are higher than urban ones, and adult infection rates are higher than children's. Dietary habits, living environment, sanitary conditions, personal habits, etc. are all risk factors for Helicobacter pylori infection.

Helicobacter pylori has the characteristics of high population infection rate, heavy disease burden and high drug resistance rate, which can cause a variety of gastrointestinal and internal and external diseases, including chronic gastritis and peptic ulcer. More seriously, Helicobacter pylori is currently the only identified bacterial pathogen closely related to the occurrence of gastric cancer, and is listed as a class I carcinogen.

In view of the current status of infection and prevention of Helicobacter pylori in mainland China, the white paper proposes that in addition to focusing on the diagnosis and eradication treatment of infected people and their family members, the population intervention strategy is the most effective strategy to reduce the burden of Helicobacter pylori infection disease at the overall level, which can reduce the risk of gastric cancer by 43%~52%.

Eradication therapy depends on the person and benefit

The Global Times Health Client reporter interviewed Xue Yan, chief physician of the Department of Gastroenterology of Peking University Third Hospital, who said that Helicobacter pylori infection is related to the age, living area, and living habits of patients. The older you are, the greater your exposure to Helicobacter pylori and the higher your chance of infection; People who regularly eat pickled foods, frequent meals and do not divide meals, and smoke have higher infection rates of Helicobacter pylori; If there is an infected person in the household, the chances of other people getting infected also increase.

Do I need eradication therapy after infection with Helicobacter pylori? Xue Yan said that receiving treatment should vary from person to person. The "Sixth National Consensus Report on the Treatment of Helicobacter Pylori Infection" formulated by the Gastroenterology Branch of the Chinese Medical Association mentioned that the eradication of Helicobacter pylori should adhere to the principle of "individualized assessment and treatment". If infected patients have peptic ulcer, gastric mucosa-associated lymphoid tissue lymphoma, Helicobacter pylori gastritis, gastric proliferative polyps, Helicobacter pylori-related dyspepsia, unexplained iron deficiency anemia, primary immune thrombocytopenia, vitamin B12 deficiency, or family history of gastric cancer, as well as early gastric cancer undergoing endoscopic submucosal dissection or subtotal gastrectomy, and planning to take nonsteroidal anti-inflammatory drugs for a long time, timely eradication of Helicobacter pylori is required.

At present, the treatment commonly used in mainland China is quadruple therapy, that is, a proton pump inhibitor (including omeprazole, lansoprazole, etc.), a bismuth agent (commonly used bismuth potassium citrate, pectin bismuth bismuth, etc.), plus two antibiotics (such as clarithromycin, amoxicillin, metronidazole, quinolones, etc.), the course of treatment is 14 days.

However, in clinical practice, physicians need to critically assess patient benefits. "Some patients who are older, have many complications, and have serious underlying conditions may not be able to tolerate drugs to eradicate Helicobacter pylori. In such cases, eradication should be decided on a case-by-case basis, even if several indications mentioned in the guidelines are met. Xue Yan especially reminded that if there is a need, the eradication of Helicobacter pylori must be carried out under the guidance of a doctor.

Pay attention to four points for prevention and control of snails

The routes of transmission of Helicobacter pylori mainly include oral-oral transmission and fecal-oral transmission, i.e., through vomit, chewing food, and contaminated water and food in infected people. In addition, it can also be transmitted by iatrogenic routes such as endoscopic procedures with incomplete sterilization, but the probability is low. Xue Yan said that the prevention and control of Helicobacter pylori infection is more important in life, and it is recommended to do the following.

Pay attention to hand hygiene. It is recommended that everyone scrub their hands with soap or hand sanitizer before eating and after using the toilet, and rinse them with running water to avoid bacteria entering the stomach.

Clean diet. Vegetables that have been applied with organic fertilizer and eaten without washing them are also at risk of contracting Helicobacter pylori. It is recommended that vegetables, melons and fruits and other foods should be fully washed before consumption, do not eat half-cooked meat, and do not drink raw cold water; Buy safe food and don't eat street stalls.

Do not share dishes and chopsticks. In addition to the stomach, the oral cavity is the most likely site for Helicobacter pylori to accumulate, and it is recommended to change the toothbrush at least every three months. If there are snail infected people in the household, you should try to avoid sharing the use of dishes and chopsticks in your daily diet, and at the same time regularly disinfect to reduce the infection of Helicobacter pylori. "Young children are most susceptible to Helicobacter pylori infection because some parents are used to chewing food and feeding it to their children, or tasting it themselves before feeding them, which can transmit Helicobacter pylori to their children." Xue Yan said.

Regular screening. If someone in the family is infected with Helicobacter pylori, it is recommended that the remaining adult members of the family do regular screening, and can go to the hospital for a breath test to rule out infection. ▲

Responsible editor: Zhao Ziying

Editor-in-chief: Ding Wenjun