Chinese Consensus Report on Family-Based Helicobacter pylori Infection Control and Management (2021 Edition)

Abstract

Objective: Helicobacter pylori infection is mostly a family-based infectious disease. To facilitate its prevention and management, a national consensus meeting was held to review current evidence and propose strategies for population-wide and family-based H. pylori infection control and management to reduce the related disease burden.

Methods: Fifty-seven experts from 41 major universities and institutions in 20 provinces/regions of mainland China were invited to review evidence and modify statements using Delphi process and grading of recommendations assessment, development and evaluation system. The consensus level was defined as ≥80% for agreement on the proposed statements.

Results: Experts discussed and modified the original 23 statements on family-based H. pylori infection transmission, control and management, and reached consensus on 16 statements. The final report consists of three parts: (1) H. pylori infection and transmission among family members, (2) prevention and management of H. pylori infection in children and elderly people within households, and (3) strategies for prevention and management of H. pylori infection for family members. In addition to the 'test-and-treat' and 'screen-and-treat' strategies, this consensus also introduced a novel third 'family-based H. pylori infection control and management' strategy to prevent its intrafamilial transmission and development of related diseases.

Conclusion: H. pylori is transmissible from person to person, and among family members. A family-based H. pylori prevention and eradication strategy would be a suitable approach to prevent its intra-familial transmission and related diseases. The notion and practice would be beneficial not only for Chinese residents but also valuable as a reference for other highly infected areas.

Keywords: 13C-urea breath test; gastric cancer; helicobacter pylori; helicobacter pylori - gastritis; mucosal infection.

Figure 1

Flowchart of family-based Helicobacter pylori infection control and management. In clinical settings, visiting patients are questioned for symptoms and signs, and Helicobacter pylori infection status is screened by urease breath tests, serological tests or stool antigen tests. If the patient is H. pylori-positive, their family members are recommended to test for H. pylori using one or more of these methods. Family members usually include parents, spouses, children and others living in the same household. The infected patients and family members are advised to treat the infection based on individual condition and follow-up in 4 weeks. If patients or their family members are H. pylori-negative, routine follow-up and no treatment are required. For patients with endoscopy-confirmed gastric precancerous lesions such as atrophy, intestinal metaplasia and intraepithelial neoplasia, H. pylori infection status should be tested, and if it is positive, eradication therapy should be offered and regular endoscopy surveillance should be performed regardless of H. pylori infection status. Dashed line with arrow indicates interaction and close relationship.