幽门螺杆菌感染处理指南系统评价
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摘要
目的:系统评价幽门螺杆菌(Helicobacter pylori,H. pylori,HP)感染处理的循证指南质量,比较指南间推荐意见的异同,对制定HP感染相关疾病的治疗策略提供指导。方法:计算机检索PubMed、Embase、SIGN(Scottish Intercollegiate Guidelines Network)、NICE(National Institute for Healthand Clinical Excellence)、NGC(National Guideline Clearinghouse)、GIN(Guidelines International Network)以及CNKI、VIP、WanFang Data数据库,纳入幽门螺杆菌感染处理的循证指南,检索时限均为2008年3月—2018年3月。使用AGREEⅡ工具评价指南的质量,分析比较各指南推荐的异同。结果:共纳入17个循证指南,其中有13个指南为循证指南,其余是否为循证指南不明确,1部指南关于儿童及青少年HP感染,11部指南关于成人HP感染,5部指南关于儿童与成人HP感染。AGREEⅡ评价结果显示,范围和目的、参与人员、严谨性、清晰性、应用性、独立性6个方面的标准化得分均值分别为71.76%、41.88%、50.18%、86.53%、22.65%、27.06%。各指南的推荐意见有差异,在某些领域还存在很大争议。结论:我国HP感染管理指南质量较低,尤其在参与人员、独立性、应用性方面需要提高,应严格按循证医学的方法,参考AGREEⅡ评分细则,制定可信赖、高质量的循证指南。
Objective:To systematically review the quality of guidelines for the treatment of HP infection and compare the similarities and differences between guidelines and provide guidance on the treatment strategies for HP infection-related diseases. Method:Databases including PubMed、Embase,Scottish Intercollegiate Guidelines Network,National Institute for Healthand Clinical Excellence,National Guideline Clearinghouse,Guidelines International Network and CNKI,VIP,WanFang Database were searched from March 2008 to March 2018 to collect guidelines concerning HP management in recent ten years. The methodological quality of included guidelines was evaluated according to the AGREE II instrument, and the differences and similarities among recommendations were compared. Results: A total of 17 evidence-based guidelines were included, Among them,13 guidelines were evidence-based guidelines, the rest were not clear, 1 guideline on HP infection in children and adolescents, 11 guidelines on adult HP infection, 5 guidelines on HP infection in children and adults. The evaluation results of AGREE II showed that the average standardized scores of the scope and purpose, stakeholder involvement, rigor of development, applicability, and independence were 71.76%, 41.88%, 50.18%, 86.53%, 22.65% and 27.06%, respectively. There were differences in the recommendations of the guidelines and there are still great controversies in some areas. Conclusion:The quality of HP infection management guidelines in China is low, especially in terms of stakeholder involvement, independence and applicability. Evidence-based medicine should be strictly followed, referring to the AGREEII scoring guidelines and we should develop reliable, high-quality evidence-based guidelines.
Objective:To systematically review the quality of guidelines for the treatment of HP infection and compare the similarities and differences between guidelines and provide guidance on the treatment strategies for HP infection-related diseases. Method:Databases including PubMed、Embase,Scottish Intercollegiate Guidelines Network,National Institute for Healthand Clinical Excellence,National Guideline Clearinghouse,Guidelines International Network and CNKI,VIP,WanFang Database were searched from March 2008 to March 2018 to collect guidelines concerning HP management in recent ten years. The methodological quality of included guidelines was evaluated according to the AGREE II instrument, and the differences and similarities among recommendations were compared. Results: A total of 17 evidence-based guidelines were included, Among them,13 guidelines were evidence-based guidelines, the rest were not clear, 1 guideline on HP infection in children and adolescents, 11 guidelines on adult HP infection, 5 guidelines on HP infection in children and adults. The evaluation results of AGREE II showed that the average standardized scores of the scope and purpose, stakeholder involvement, rigor of development, applicability, and independence were 71.76%, 41.88%, 50.18%, 86.53%, 22.65% and 27.06%, respectively. There were differences in the recommendations of the guidelines and there are still great controversies in some areas. Conclusion:The quality of HP infection management guidelines in China is low, especially in terms of stakeholder involvement, independence and applicability. Evidence-based medicine should be strictly followed, referring to the AGREEII scoring guidelines and we should develop reliable, high-quality evidence-based guidelines.
引文
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[5] 王维, 陈青山, 刘治民. 应用Excel完成组内相关系数ICC的计算和评价[J]. 中国卫生统计, 2008, 25(3): 314-315.
[6] Chey WD,Leontiadis GI,Howden CW.ACG Clinical Guideline: Treatment of Helicobacter pylori Infection[J].The American journal of gastroenterology,2017,112(2):212-239.
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[9] Zagari RM,Romano M,Ojetti V,et al.Guidelines for the management of Helicobacter pylori infection in Italy: The III Working Group Consensus Report 2015[J].Digestive and liver disease: official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver,2015,47(11):903-912.
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[11] Hunt RH,Xiao SD,Megraud F,et al.Helicobacter pylori in developing countries World Gastroenterology Organisation Global Guideline[J].Journal of gastrointestinal and liver diseases: JGLD,2011,20(3):299-304.
[12] Thirumurthi S.Helicobacter pylori infection in India from a western perspective[J].Indian journal of medical sciences,2010,64(9):423-440.
[13] Jones NL,Koletzko S,Goodman K,et al.Joint ESPGHAN/NASPGHAN Guidelines for the Management of Helicobacter pylori in Children and Adolescents (Update 2016)[J].Journal of pediatric gastroenterology and nutrition,2017,64(6):991-1003.
[14] Rollan A,Arab JP,Camargo MC,et al.Management of Helicobacter pylori infection in Latin America: a Delphi technique-based consensus[J].World journal of gastroenterology,2014,20(31):10969-10983.
[15] Malfertheiner P,Megraud F,O’Morain CA,et al.Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report[J].Gut,2017,66(1):6-30.
[16] Smith S,Boyle B,Brennan D,et al.The Irish Helicobacter pylori Working Group consensus for the diagnosis and treatment of H pylori infection in adult patients in Ireland[J].European journal of gastroenterology & hepatology,2017,29(5):552-559.
[17] Mahachai V,Vilaichone RK,Pittayanon R,et al.Thailand Consensus on Helicobacter pylori Treatment 2015[J].Asian Pacific journal of cancer prevention: APJCP,2016,17(5):2351-2360.
[18] Fock KM,Katelaris P,Sugano K,et al.Second Asia-Pacific Consensus Guidelines for Helicobacter pylori infection[J].Journal of gastroenterology and hepatology,2009,24(10):1587-1600.
[19] Fischbach W,Malfertheiner P,Hoffmann JC,et al.S3-guideline “helicobacter pylori and gastroduodenal ulcer disease” of the German society for digestive and metabolic diseases (DGVS) in cooperation with the German society for hygiene and microbiology, society for pediatric gastroenterology and nutrition e V, German society for rheumatology, AWMF-registration-no 021/001[J].Zeitschrift für Gastroenterologie,2009,47(12):1230-1263.
[20] Fallone CA,Chiba N,van Zanten SV,et al.The Toronto Consensus for the Treatment of Helicobacter pylori Infection in Adults[J].Gastroenterology,2016,151(1):51-69.
[21] 刘文忠,谢勇,陆红,等.第五次全国幽门螺杆菌感染处理共识报告[J].胃肠病学,2017,22(6):346-360.
[22] Kokkola A, Rautelin H, Puolakkainen P, et al. Diagnosis of Helicobacter pylori infection in patients with atrophic gastritis:comparison of histology, 13C-urea breath test, and serology[J]. Scand Gastroenterol,2000, 35: 138-141.
[23] Ekstrom AM, Held M, Hansonn LE, et al. Helicobacter pylori in gastric cancer established by CagA immunoblot as a marker of past infection[J].Gastroenterology, 2001,121:784-791.
[24] Kosunen TU, Seppala K, Sarna S, et al. Diagnostic value of decreasing IgG, IgA, and IgM antibody titres after eradication of Helicobacter pylori[J]. Lancet, 1992,339:893-895.
[25] Study group on preparing evidence-based guidelines for the treatment of gastric ulcer. Eradication Therapy[M]. Guidelines for the Treatment of Gastric Ulcer Based on EBM [in Japanese]. Tokyo:Jiho, 2003.
[26] Dixon MF, Genta RM, Yardley JH, et al.Classifcation and grading of gastritis. The updated Sydney system[J]. International Workshop on the Histopathology of Gastritis, 1996,20:1161-1181.
[27] Wang J, Xu L,Shi R, Huang X, et al. Gastric atrophy and intestinal metaplasia before and after Helicobacter pylori eradication: a meta-analysis[J]. Digestion,2011,83:253-260.
[28] Huang X, Qu X, Yan W, et al. Iron defciency anaemia can be improved after eradication of Helicobacter pylori[M]. Postgrad Med,2010.
[29] Arnold DM, Bernotas A, Nazi I, et al. Platelet count response to H pylori treatment in patients with immune thrombocytopenic purpura with and without H pylori infection: a systematic review[M]. Haematologica,2009,94:850-856.
[30] Bu XL, Yao XQ, Jiao SS, et al. A study on the association between infectious burden and Alzheimer’s disease[J]. Eur J Neurol, 2015,22:1519-1525.
[31] Roubaud-Baudron C, Krolak-Salmon P, Quadrio I, et al. Impact of chronic Helicobacter pylori infection on Alzheimer’s disease: preliminary results[J]. Neurobiol Aging, 2012,33:1009.
[32] Bu XL, Wang X, Xiang Y, et al. The association between infectious burden and Parkinson’s disease: a case-control study[J]. Parkinsonism Relat Disord, 2015,21:877-881.
[33] Dobbs SM, Charlett A, Dobbs RJ, et al. Antimicrobial surveillance in idiopathic parkinsonism: indication-specific improvement in hypokinesia following Helicobacter pylori eradication and non-specific effect of antimicrobials for other indications in worsening rigidity[J]. Helicobacter, 2013,18:187-196.
[34] El-Omar EM, Penman ID, Ardill JE, et al. Helicobacter pylori infection and abnormalities of acid secretion in patients with duodenal ulcer disease[J]. Gastroenterology, 1995, 109: 681-691.
[35] O’Connor HJ. Helicobacter pylori and gastro-oesophageal reflux disease-clinical implications and management[J]. Aliment Pharmacol Ther, 1999, 13: 117-127.
[36] Moayyedi P, Bardhan C, Young L, et al.Helicobacter pylori eradication does not exacerbate reflux symptoms in gastroesophageal reflux disease[J]. Gastroenterology, 2001, 121: 1120-1126.
[37] Yaghoobi M, Farrokhyar F, Yuan Y, et al. Is there an increased risk of GERD after Helicobacter pylori eradication?: a meta-analysis[J]. Am. J. Gastroenterol,2010, 105: 1007-1013.
[38] Moayyedi P, Bardhan C, Young L, et al. Helicobacter pylori eradication does not exacerbate re?ux symptoms in gastroesophageal re?ux disease[J]. Gastroenterology,2001,121:1120-1126.
[39] Chey WD, Wong BCY. American College of Gastroenterology Guideline on the management of Helicobacter pylori infection[J].Am J Gastroenterol, 2007,102:1808-1825.
[40] Fukuchi T, Ashida K, Yamashita H, et al. Influence of cure of Helicobacter pylori infection on gastric acidity and gastroesophageal reflux: study by 24-h pH monitoring in patients with gastric or duodenal ulcer[J]. J Gastroenterol, 2005,40:350-360.
[41] 叶蔚,姚嘉明,刘彬彬,等.反流性食管炎不同中医证型幽门螺杆菌感染的研究[J].中华中医药学刊,2013,31(3):531-532.
[42] Ojetti V, Bruno G, Ainora ME, et al. Impact of Lactobacillus reuteri supplementation on anti-Helicobacter pylori levofloxacin-based second-line therapy[J].Gastroenterology Research and Practice, 2012,2012:740381.
[43] Ruggero P. Use of probiotics in the fight against Helicobacter pylori[J]. WorldJournal of Gastroenterology, 2014,5:384-391.
[44] 李瀚旻,严永祥,程思思. 幽门螺杆菌的中医治疗与进展[J]. 中华中医药学刊,2014,32(9):2055-2057.
[2] Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care[J].CMAJ, 2010, 182(18): E839-E842.
[3] AGREE Next Steps Consortium. Te AGREE II Instrument[EB/OL]. 2009.Available at: http://www.agreetrust.org/resource-centre/agree-ii/.
[4] 陈尹, 胡世莲, 李幼平, 等. 全球药物干预治疗单纯性高血压指南的系统评价[J]. 中国循证医学杂志, 2012, 12(10): 1180-1194.
[5] 王维, 陈青山, 刘治民. 应用Excel完成组内相关系数ICC的计算和评价[J]. 中国卫生统计, 2008, 25(3): 314-315.
[6] Chey WD,Leontiadis GI,Howden CW.ACG Clinical Guideline: Treatment of Helicobacter pylori Infection[J].The American journal of gastroenterology,2017,112(2):212-239.
[7] Bytzer P,Dahlerup JF,Eriksen JR,et al.Diagnosis and treatment of Helicobacter pylori infection[J].Danish medical bulletin,2011,58(4):C4271.
[8] Kim SG,Jung HK,Lee HL,et al.Guidelines for the diagnosis and treatment of Helicobacter pylori infection in Korea, 2013 revised edition[J].The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi,2013,62(1):3-26.
[9] Zagari RM,Romano M,Ojetti V,et al.Guidelines for the management of Helicobacter pylori infection in Italy: The III Working Group Consensus Report 2015[J].Digestive and liver disease: official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver,2015,47(11):903-912.
[10] Asaka M,Kato M,Takahashi S,et al.Guidelines for the management of Helicobacter pylori infection in Japan: 2009 revised edition[J].Helicobacter,2010,15(1):1-20.
[11] Hunt RH,Xiao SD,Megraud F,et al.Helicobacter pylori in developing countries World Gastroenterology Organisation Global Guideline[J].Journal of gastrointestinal and liver diseases: JGLD,2011,20(3):299-304.
[12] Thirumurthi S.Helicobacter pylori infection in India from a western perspective[J].Indian journal of medical sciences,2010,64(9):423-440.
[13] Jones NL,Koletzko S,Goodman K,et al.Joint ESPGHAN/NASPGHAN Guidelines for the Management of Helicobacter pylori in Children and Adolescents (Update 2016)[J].Journal of pediatric gastroenterology and nutrition,2017,64(6):991-1003.
[14] Rollan A,Arab JP,Camargo MC,et al.Management of Helicobacter pylori infection in Latin America: a Delphi technique-based consensus[J].World journal of gastroenterology,2014,20(31):10969-10983.
[15] Malfertheiner P,Megraud F,O’Morain CA,et al.Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report[J].Gut,2017,66(1):6-30.
[16] Smith S,Boyle B,Brennan D,et al.The Irish Helicobacter pylori Working Group consensus for the diagnosis and treatment of H pylori infection in adult patients in Ireland[J].European journal of gastroenterology & hepatology,2017,29(5):552-559.
[17] Mahachai V,Vilaichone RK,Pittayanon R,et al.Thailand Consensus on Helicobacter pylori Treatment 2015[J].Asian Pacific journal of cancer prevention: APJCP,2016,17(5):2351-2360.
[18] Fock KM,Katelaris P,Sugano K,et al.Second Asia-Pacific Consensus Guidelines for Helicobacter pylori infection[J].Journal of gastroenterology and hepatology,2009,24(10):1587-1600.
[19] Fischbach W,Malfertheiner P,Hoffmann JC,et al.S3-guideline “helicobacter pylori and gastroduodenal ulcer disease” of the German society for digestive and metabolic diseases (DGVS) in cooperation with the German society for hygiene and microbiology, society for pediatric gastroenterology and nutrition e V, German society for rheumatology, AWMF-registration-no 021/001[J].Zeitschrift für Gastroenterologie,2009,47(12):1230-1263.
[20] Fallone CA,Chiba N,van Zanten SV,et al.The Toronto Consensus for the Treatment of Helicobacter pylori Infection in Adults[J].Gastroenterology,2016,151(1):51-69.
[21] 刘文忠,谢勇,陆红,等.第五次全国幽门螺杆菌感染处理共识报告[J].胃肠病学,2017,22(6):346-360.
[22] Kokkola A, Rautelin H, Puolakkainen P, et al. Diagnosis of Helicobacter pylori infection in patients with atrophic gastritis:comparison of histology, 13C-urea breath test, and serology[J]. Scand Gastroenterol,2000, 35: 138-141.
[23] Ekstrom AM, Held M, Hansonn LE, et al. Helicobacter pylori in gastric cancer established by CagA immunoblot as a marker of past infection[J].Gastroenterology, 2001,121:784-791.
[24] Kosunen TU, Seppala K, Sarna S, et al. Diagnostic value of decreasing IgG, IgA, and IgM antibody titres after eradication of Helicobacter pylori[J]. Lancet, 1992,339:893-895.
[25] Study group on preparing evidence-based guidelines for the treatment of gastric ulcer. Eradication Therapy[M]. Guidelines for the Treatment of Gastric Ulcer Based on EBM [in Japanese]. Tokyo:Jiho, 2003.
[26] Dixon MF, Genta RM, Yardley JH, et al.Classifcation and grading of gastritis. The updated Sydney system[J]. International Workshop on the Histopathology of Gastritis, 1996,20:1161-1181.
[27] Wang J, Xu L,Shi R, Huang X, et al. Gastric atrophy and intestinal metaplasia before and after Helicobacter pylori eradication: a meta-analysis[J]. Digestion,2011,83:253-260.
[28] Huang X, Qu X, Yan W, et al. Iron defciency anaemia can be improved after eradication of Helicobacter pylori[M]. Postgrad Med,2010.
[29] Arnold DM, Bernotas A, Nazi I, et al. Platelet count response to H pylori treatment in patients with immune thrombocytopenic purpura with and without H pylori infection: a systematic review[M]. Haematologica,2009,94:850-856.
[30] Bu XL, Yao XQ, Jiao SS, et al. A study on the association between infectious burden and Alzheimer’s disease[J]. Eur J Neurol, 2015,22:1519-1525.
[31] Roubaud-Baudron C, Krolak-Salmon P, Quadrio I, et al. Impact of chronic Helicobacter pylori infection on Alzheimer’s disease: preliminary results[J]. Neurobiol Aging, 2012,33:1009.
[32] Bu XL, Wang X, Xiang Y, et al. The association between infectious burden and Parkinson’s disease: a case-control study[J]. Parkinsonism Relat Disord, 2015,21:877-881.
[33] Dobbs SM, Charlett A, Dobbs RJ, et al. Antimicrobial surveillance in idiopathic parkinsonism: indication-specific improvement in hypokinesia following Helicobacter pylori eradication and non-specific effect of antimicrobials for other indications in worsening rigidity[J]. Helicobacter, 2013,18:187-196.
[34] El-Omar EM, Penman ID, Ardill JE, et al. Helicobacter pylori infection and abnormalities of acid secretion in patients with duodenal ulcer disease[J]. Gastroenterology, 1995, 109: 681-691.
[35] O’Connor HJ. Helicobacter pylori and gastro-oesophageal reflux disease-clinical implications and management[J]. Aliment Pharmacol Ther, 1999, 13: 117-127.
[36] Moayyedi P, Bardhan C, Young L, et al.Helicobacter pylori eradication does not exacerbate reflux symptoms in gastroesophageal reflux disease[J]. Gastroenterology, 2001, 121: 1120-1126.
[37] Yaghoobi M, Farrokhyar F, Yuan Y, et al. Is there an increased risk of GERD after Helicobacter pylori eradication?: a meta-analysis[J]. Am. J. Gastroenterol,2010, 105: 1007-1013.
[38] Moayyedi P, Bardhan C, Young L, et al. Helicobacter pylori eradication does not exacerbate re?ux symptoms in gastroesophageal re?ux disease[J]. Gastroenterology,2001,121:1120-1126.
[39] Chey WD, Wong BCY. American College of Gastroenterology Guideline on the management of Helicobacter pylori infection[J].Am J Gastroenterol, 2007,102:1808-1825.
[40] Fukuchi T, Ashida K, Yamashita H, et al. Influence of cure of Helicobacter pylori infection on gastric acidity and gastroesophageal reflux: study by 24-h pH monitoring in patients with gastric or duodenal ulcer[J]. J Gastroenterol, 2005,40:350-360.
[41] 叶蔚,姚嘉明,刘彬彬,等.反流性食管炎不同中医证型幽门螺杆菌感染的研究[J].中华中医药学刊,2013,31(3):531-532.
[42] Ojetti V, Bruno G, Ainora ME, et al. Impact of Lactobacillus reuteri supplementation on anti-Helicobacter pylori levofloxacin-based second-line therapy[J].Gastroenterology Research and Practice, 2012,2012:740381.
[43] Ruggero P. Use of probiotics in the fight against Helicobacter pylori[J]. WorldJournal of Gastroenterology, 2014,5:384-391.
[44] 李瀚旻,严永祥,程思思. 幽门螺杆菌的中医治疗与进展[J]. 中华中医药学刊,2014,32(9):2055-2057.