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Gut and Liver https://doi.org/10.5009/gnl20288 Evidence-Based Guidelines for the Treatment of Helicobacter pylori Infection in Korea 2020
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Hye-Kyung Jung1 , Seung Joo Kang2 , Yong Chan Lee3 , Hyo-Joon Yang4 , Seon-Young Park5 , Cheol Min Shin6 , Sung Eun Kim7 , Hyun Chul Lim8 , Jie-Hyun Kim9 , Su Youn Nam10 , Woon Geon Shin11 , Jae Myung Park12 , Il Ju Choi13 , Jae Gyu Kim14 , and Miyoung Choi15 , Korean College of Helicobacter and Upper Gastrointesinal Research
1Department of Internal Medicine, Ewha Womans University School of Medicine, 2Department of Internal Medicine, Seoul National University Hospital Gangnam Center, 3Department of Internal Medicine, Yonsei University College of Medicine, 4Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 5Department of Internal Medicine, Chonnam National University Medical School, Gwangju, 6Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, 7Department of Internal Medicine, Kosin University College of Medicine, Busan, 8Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, 9Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, 10Center for Gastric Cancer, Kyungpook National University Hospital Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, 11Department of Internal Medicine, Hallym University College of Medicine, 12Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, 13Center for Gastric Cancer, National Cancer Center, Goyang, 14Department of Internal Medicine, Chung-Ang University College of Medicine, and 15Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea

Yong Chan Lee
ORCID https://orcid.org/0000-0001-8800-6906
E-mail leeyc@yuhs.ac
Hye-Kyung Jung and Seung Joo Kang contributed equally to this work as first authors.
© The Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, the Korean Society of Neurogastroenterology and Motility, Korean College of Helicobacter and Upper Gastrointestinal Research, Korean Association the Study of Intestinal Diseases, the Korean Association for the Study of the Liver, Korean Pancreatobiliary Association, and Korean Society of Gastrointestinal Cancer. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Helicobacter pylori infection is one of the most common infectious diseases worldwide. Although the prevalence of H. pylori is gradually decreasing, approximately half of the world's population still becomes infected with this disease. H. pylori is responsible for substantial gastrointestinal morbidity worldwide, with a high disease burden. It is the most common cause of gastric and duodenal ulcers and gastric cancer. Since the revision of the H. pylori clinical practice guidelines in 2013 in Korea, the eradication rate of H. pylori has gradually decreased with the use of a clarithromycin-based triple therapy for 7 days. According to a nationwide randomized controlled study conducted by the Korean College of Helicobacter and Upper Gastrointestinal Research released in 2018, the intention-to-treat eradication rate was only 63.9%, which was mostly due to increased antimicrobial resistance, especially from clarithromycin. The clinical practice guidelines for the treatment of H. pylori were updated according to evidence-based medicine from a metaanalysis conducted on a target group receiving the latest level of eradication therapy. The draft recommendations developed based on the meta-analysis were finalized after an expert consensus on three recommendations regarding the indication for treatment and eight recommendations for the treatment itself. These guidelines were designed to provide clinical evidence for the treatment (including primary care treatment) of H. pylori infection to patients, nurses, medical school students, policymakers, and clinicians. These may differ from current medical insurance standards and will be revised if more evidence emerges in the future.
Keywords: Helicobacter pylori; Guidelines; Treatment; Meta-analysis; Microbial sensitivity tests
Abstract
Helicobacter pylori infection is one of the most common infectious diseases worldwide. Although the prevalence of H. pylori is gradually decreasing, approximately half of the world's population still becomes infected with this disease. H. pylori is responsible for substantial gastrointestinal morbidity worldwide, with a high disease burden. It is the most common cause of gastric and duodenal ulcers and gastric cancer. Since the revision of the H. pylori clinical practice guidelines in 2013 in Korea, the eradication rate of H. pylori has gradually decreased with the use of a clarithromycin-based triple therapy for 7 days. According to a nationwide randomized controlled study conducted by the Korean College of Helicobacter and Upper Gastrointestinal Research released in 2018, the intention-to-treat eradication rate was only 63.9%, which was mostly due to increased antimicrobial resistance, especially from clarithromycin. The clinical practice guidelines for the treatment of H. pylori were updated according to evidence-based medicine from a metaanalysis conducted on a target group receiving the latest level of eradication therapy. The draft recommendations developed based on the meta-analysis were finalized after an expert consensus on three recommendations regarding the indication for treatment and eight recommendations for the treatment itself. These guidelines were designed to provide clinical evidence for the treatment (including primary care treatment) of H. pylori infection to patients, nurses, medical school students, policymakers, and clinicians. These may differ from current medical insurance standards and will be revised if more evidence emerges in the future.
Keywords: Helicobacter pylori; Guidelines; Treatment; Meta-analysis; Microbial sensitivity tests
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