教育演講6:幽門螺旋桿菌與胃腸道疾病
Helicobacter pylori and gastrointestinal tract disorders

程 序 表

E6-2
Treatment for H. pylori infection
許博翔
國立成功大學醫學院附設醫院內科

 Helicobacter pylori infection has been discovered for near two three since 1983. The bacterial infection is a worldwide leading related to peptic ulcer and even gastric carcinogenesis. It is recognized as type I carcinogen by WHO at 1994. Eradication of this infection is now the mainstream to control peptic ulcer, and even be promising to prevent gastric cancer. The Maastricht consensus beheld by European H. pylori study group (EHPSG) address evolutional witness to the clinical guidelines since 1996 as Maastricht I, 2000 as Maastricht II, 2005 as Maastricht III, and now updated as Maastricht IV. Such guideline processes the indication, recommended treatment regimens, and potential highlights for the forward demanding research prospects. The indications cover the absolute, probable, and possible in patterns to fit the different clinical situations to receive H. pylori eradication. The evolutions progress of H. pylori eradication from dual, triple, quadruple, sequential therapy, and even combined concomitant regimens during the past 3 decades. The overall goal is to achieve the eradication rate of such infection with intention-to-treat analysis at least 85%, and per-protocol as better as near to 90% and better. The better compliance, and least adverse effect and antimicrobial resistance shall be the optimal demand in the regimens. The supplementations of probiotics, nature products, or even immune modulation are also with benefits to decrease side effects and to overcome antimicrobial resistance. Otherwise, the extension of H. pylori eradication as early before the precancerous change existence shall be important, especially in the high endemic area of gastric cancer or even at the populations infected by more toxic virulence strains. Screening out the risky patient for early H. pylori eradication should be thus in need of future research. Besides, once the H. pylori eradication can be achieved in the patients with precancerous changes, the persistent COX-2 remains. The COX-2 suppression to regress or at least prevent the progression of precancerous changes will be introduced via our Taiwanese experiences.
Highlights of lectures:
1. Evolution of Maastricht in the eradication indication
2. Classic therapy and alternative therapy to overcome antimicrobial resistance
3. Eradication the H. pylori before precancerous lesions treat as early
4. Beyond H. pylori eradication to control carcinogenesis, our COX-2 story in Tainan, Taiwan.