Journal List > Korean J Gastroenterol > v.62(1) > 1007162

Kim, Jung, Lee, Jang, Lee, Kim, Shin, Shin, and Lee: Guidelines for the Diagnosis and Treatment of Helicobacter pylori Infection in Korea, 2013 Revised Edition

Abstract

Since the Korean College of Helicobacter and Upper Gastrointestinal Research has first developed the guideline for the diagnosis and treatment of Helicobacter pylori infection in 1998, the revised guideline was proposed in 2009 by the same group. Although the revised guideline was made by comprehensive review of previous articles and consensus of authoritative expert opinions, the evidence-based developmental process was not applied in the revision of the guideline. This new guideline has been revised especially in terms of changes in the indication and treatment of H. pylori infection in Korea, and developed by the adaptation process as evidence-based method; 6 guidelines were retrieved by systematic review and the Appraisal of Guidelines for Research and Evaluation (AGREE) II process, 21 statements were made with grading system and revised by modified Delphi method. After revision, 11 statements for the indication of test and treatment, 4 statements for the diagnosis and 4 statements for the treatment have been developed, respectively. The revised guideline has been reviewed by external experts before the official endorsement, and will be disseminated for usual clinical practice in Korea. Also, the scheduled update and revision of the guideline will be made periodically.

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Fig. 1.
Flowchart of study selection.
kjg-62-3f1.tif
Fig. 2.
Appraisal results of candidate guidelines by the Appraisal of Guidelines for Research & Evaluation II process (AGREE II). Selected guidelines number: 1, Canadian; 2, American College of Gastroenterology (ACG); 3, Japan; 4, Asian-Pacific (AP); 5, Korean College of Helicobacter and Upper Gastrointestinal Research; 6, Maastricht.
kjg-62-3f2.tif
Fig. 3.
Algorithm of Helicobacter pylori eradication. Triple therapy, proton pump inhibitor (PPI) standard dose two times a day (bid), amoxicillin 1 g bid, clarithromycin 500 mg bid for 7–14 days; Bis-muth-based quadruple therapy, PPI standard dose bid, metronidazole 500 mg three times a day (tid), bismuth 120 mg four times a day (qid), tetracycline 500 mg qid for 7–14 days; Regimen including other 2 or more antibiotics, combination with other 2 or more antibiotics except metronidazole and tetracycline which were used in first-line therapy.
kjg-62-3f3.tif
Table 1.
Data Extraction Form/Evidence Inventory Form for First Line Helicobacter pylori Eradication
Item Guideline/country/synopsis of recommendations Supporting evidence
SR/MA NR RCT NRCS CS G Other
First line G1 (Korean) Triple therapy for 1 to 2 weeks 0 0 2 1 0 0 0
Helicobacter pylori eradication G4 (Asian-Pacific) Triple therapy for 1 week, bismuth based quadruple as alternative 2 0 1 0 0 0 0
  G6 (Japan) Triple therapy for 1 week, 10 days sequential therapy 1 0 6 7 0 4 0
  G8 (Canada) Quadruple therapy for 10 to 14 days 4 2 1 4 0 1 0
  G9 (Maastricht) Triple therapy for 1 to 2 weeks, bismuth based quadruple as alternative 0 1 0 0 0 1 0
  G10 (American College of Gastroenterology) Triple or quadruple therapy for 2 weeks 2 2 5 3 0 0 0

CS, case series study; G, guideline; SR/MA, systemic review/meta-analysis; NR, nonsystematic, narrative review; NRCS, non-randomized comparative study; RCT, randomized controlled trial.

Table 2.
Retrieval of Statements in Adaptation Process
Guideline Number of key recommendations Year of publication Strong recommendation Weak recommendation Not applicable
Canadian Helicobacter Study Group consensus 7 2004 3 1 3
American College Gastroenterology 18 2007 14 3 1
Japan; updated 15 2009 7 2 6
2nd Asian-Pacific consensus 15 2009 14 1 0
Korean guidelines for Helicobacter pylori 12 2009 9 1 2
Maastricht IV 18 2012 14 3 1
Table 3.
Level of Evidence and Grade of Recommendation
Item Definition
Level of evidence
A. High-quality evidence Further research is unlikely to change our confidence in the estimate of effect. Consistent evidence from the randomized controlled trial (RCTs) without important limitations or exceptionally strong evidence from observational studies.
B. Moderate-quality evidence Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Evidence from RCTs with important limitations (inconsistent results, methodologic flaws, indirect or imprecise), or very strong evidence from observational studies.
C. Low-quality evidence Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Evidence for at least one critical outcome from observational studies, case series, or from RCTs with serious flaws, or indirect evidence, or expert's consensus.
Strength of recommendation
1. Strong recommendation Recommendation can apply to most patients in most circumstances.
2. Weak recommendation The best action may differ depending on circumstances or patient or society values. Other alternatives may be equally reasonable.
Appendix 1.
Formulate Research Question
No. Keyword Results Search category No. Keyword Results Search category
Recall ratio Recall ratio
1 Helicobacter 17,868 MeSH 42 Diagnosis 1,760,076 Subheading
2 Helicobacter 20,773 All fields 43 Diagnoses 2,737,004 All fields
3 Helicobacter 14,141 Title word 44 Diagnoses 2,224 Title word
4 Pylori 20,503 All fields 45 OR / 26–44 4,490,406  
5 Pylori 14,423 Title word 46 25 OR 45 4,495,351  
6 Helicobacter pylori 17,553 MeSH 47 12 AND 46 16,570  
7 Helicobacter pylori 20,159 All fields 48 Guideline 73,666 MeSH
8 Helicobacter pylori 13,682 Title word 49 Guideline 13,931 Pub type
9 Helicobacter Infections 15,937 MeSH 50 Guideline 97,971 All fields
10 Helicobacter Infections 15,944 All fields 51 Guideline 3,591 Title word
11 Helicobacter Infections 5 Title word 52 Guideline* 152,119 All fields
12 OR / 1–11 21,054   53 Guideline* 24,046 Title word
13 Disease Eradication 55 MeSH 54 Guidelines as Topic 73,666 MeSH
14 Disease Eradication 194 All fields 55 Guidelines as Topic 72,318 All fields
15 Disease Eradication 38 Title word 56 Guidelines as Topic 0 Title word
16 Eradication 12,886 All fields 57 Guideline Adherence 13,266 MeSH
17 Eradication 3,691 Title word 58 Guideline Adherence 13,361 All fields
18 Clinical Protocols 66,307 MeSH 59 Guideline Adherence 84 Title word
19 Clinical Protocols 11,350 All fields 60 Practice Guideline 11,382 Pub type
20 Clinical Protocols 51 Title word 61 Practice Guideline 12,468 All fields
21 Regimen 122,451 All fields 62 Practice Guideline 704 Title word
22 Regimen 4,489 Title word 63 Practice Guidelines as Topic 53,019 MeSH
23 Indication 29,575 All fields 64 Practice Guidelines as Topic 53,019 All fields
24 Indication 1,861 Title word 65 Practice Guidelines as Topic 0 Title word
25 OR / 13–24 162,515   66 Clinical Guideline 472 All fields
26 Therapeutics 1,298,453 MeSH 67 Clinical Guideline 162 Title word
27 Therapeutics 3,121,607 All fields 68 Clinical Practice Guideline 949 All fields
28 Therapeutics 3,166 Title word 69 Clinical Practice Guideline 424 Title word
29 Therapy 2,204,249 Subheading 70 OR / 48–69 153,362  
30 Therapy 2,735,562 All fields 71 Consensus 2,921 MeSH
31 Therapy 145,200 Title word 72 Consensus 52,563 All fields
32 Treatment 2,979,451 All fields 73 Consensus 6,658 Title word
33 Treatment 244,278 Title word 74 Recommendation 11,092 All fields
34 Therapeutic use 1,355,068 Subheading 75 Recommendation 799 Title word
35 Therapeutic use 714,190 All fields 76 Recommendation* 73,160 All fields
36 Therapeutic use 438 Title word 77 Recommendation* 10,339 Title word
37 Therap* 929,658 All fields 78 Workshop 400,115 All fields
38 Therap* 191,213 Title word 79 Workshop 4,377 Title word
39 Diagnosis 2,355,852 MeSH 80 OR / 71–79 502,082  
40 Diagnosis 3,058,562 All fields 81 70 OR 80 607,579  
41 Diagnosis 71,766 Title word 82 47 AND 81 1,013  
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