Helicobacter pylori in Alaska Natives - Revision history

LiamG at 13:01, 24 September 2024

2024-09-24T13:01:29Z

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 * CDC Slide Show[[media:Hpylori Update.pdf|''Updates on H. Pylori Research in Alaska 2016'']]
 * [[media:H_pylori_dyspepsia.pdf|Dyspepsia (H. pylori) YKHC Clinical Guideline]]
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 <br>

AndyS at 01:28, 13 January 2022

2022-01-13T01:28:23Z

← Older revision		Revision as of 01:28, 13 January 2022
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	===Pediatric Considerations===		===Pediatric Considerations===
			The management algorithm is the same for adult and pediatric patients. However, local pediatric EGD's are only available for teens who are essentially adult size.
	<br>		<br>
	<br>		<br>

AndyS at 00:45, 13 January 2022

2022-01-13T00:45:13Z

← Older revision		Revision as of 00:45, 13 January 2022
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	Helicobacter pylori is present in the stomach of the majority of adult Alaska Natives, with a similar prevalence in other circumpolar indigenous peoples (such as in Canada, Greenland, Russia, etc). The high prevalance, high drug resistance rate, and high reinfection rate present unique challenges for management of Alaska Natives with dyspepsia symptoms.		Helicobacter pylori is present in the stomach of the majority of adult Alaska Natives, with a similar prevalence in other circumpolar indigenous peoples (such as in Canada, Greenland, Russia, etc). The high prevalance, high drug resistance rate, and high reinfection rate present unique challenges for management of Alaska Natives with dyspepsia symptoms.

			==Background==
	===Research===		===Research===
	A substantial amount of research has been published regarding this topic. As of October 2017, PubMed search for		A substantial amount of research has been published regarding this topic. As of October 2017, PubMed search for
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	===Pediatric Considerations===		===Pediatric Considerations===
			<br>
			<br>

	===SUMMARY===		==SUMMARY==
	----		----
	# '''Substantial research supports a different diagnostic and treatment algorithm for H. pylori in high prevalence populations.'''		# '''Substantial research supports a different diagnostic and treatment algorithm for H. pylori in high prevalence populations.'''
	# '''When dyspepsia fails to respond to a PPI, patients should be referred for EGD.'''		# '''When dyspepsia fails to respond to a PPI, patients should be referred for EGD.'''
			<br>
			<br>

	===Resources===		===Resources===
	* [[media:Hpylori Update.pdf\|Updates on H. Pylori Research in Alaska 2016]]		* CDC Slide Show[[media:Hpylori Update.pdf\|''Updates on H. Pylori Research in Alaska 2016'']]
	* [http://anmc.org/files/CG_HelicobacterPyloriGuideline_010917.pdf <u>ANMC H. pylori guideline</u>]
	* [[media:H_pylori_dyspepsia.pdf\|Dyspepsia (H. pylori) YKHC Clinical Guideline]]		* [[media:H_pylori_dyspepsia.pdf\|Dyspepsia (H. pylori) YKHC Clinical Guideline]]
			<br>
			<br>

			==Treatment Guidelines==
			===YKHC H. Pylori Treatment Guidelines===
			{\| class="wikitable"
			\|-
			! Date !! Guideline !! Revision Notes !! Status
			\|-
			\| 04/26/2018 \|\| [[File:H_pylori_dyspepsia.pdf\|100px\|Guideline]] \|\| None \|\| '''Active'''
			\|-
			\| 01/12/2022 \|\| \|\| [[H_Pylori_Guideline_Revision_Supplement_2022\|2022 Revision Notes]] \|\| Pending
			\|}
			<br>
			<br>

			===ANMC H. Pylori Treatment Guidelines===
			* Nov 2016 ([https://web.archive.org/web/20180107084913/http://anmc.org/files/CG_HelicobacterPyloriGuideline_010917.pdf Archive])<br>
			* [https://anmc.org/files/CG_HelicobacterPyloriGuideline.pdf Feb 19, 2020 ]([https://web.archive.org/web/20201024034528/https://anmc.org/files/CG_HelicobacterPyloriGuideline.pdf Archive])<br>
			<br>
			<br>

	[[:category:YKHC Guidelines\|YKHC Clinical Guidelines]]		[[:category:YKHC Guidelines\|YKHC Clinical Guidelines]]
	<br/>[[Practicing Medicine in Bush Alaska—Some ABCs\|Common/Unique Medical Diagnoses]]		<br/>[[Practicing Medicine in Bush Alaska—Some ABCs\|Common/Unique Medical Diagnoses]]
			<br>
			<br>

	===References===		==References==
	----		----

JenniferH at 13:44, 21 November 2020

2020-11-21T13:44:11Z

← Older revision		Revision as of 13:44, 21 November 2020
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	Helicobacter pylori is present in the stomach of the majority of adult Alaska Natives, with a similar prevalence in other circumpolar indigenous peoples (such as in Canada, Greenland, Russia, etc). The high prevalance, high drug resistance rate, and high reinfection rate present unique challenges for management of Alaska Natives with dyspepsia symptoms.		Helicobacter pylori is present in the stomach of the majority of adult Alaska Natives, with a similar prevalence in other circumpolar indigenous peoples (such as in Canada, Greenland, Russia, etc). The high prevalance, high drug resistance rate, and high reinfection rate present unique challenges for management of Alaska Natives with dyspepsia symptoms.



	===Research===		===Research===
	A substantial amount of research has been published regarding this topic. As of October 2017, PubMed search for		A substantial amount of research has been published regarding this topic. As of October 2017, PubMed search for
	[https://www.ncbi.nlm.nih.gov/pubmed?term=(alaska%5BTitle%5D%20OR%20polar%5BTitle%5D%20OR%20arctic%5BTitle%5D)%20AND%20helicobacter%5BTitle%5D <u>(alaska[Title] OR polar[Title] OR arctic[Title]) AND helicobacter[Title]]</u> returned 29 articles. In June of 2016 researchers from the CDC presented Grand Rounds at YKHC and gave [[media:Hpylori Update.pdf\|<u>this excellent talk</u>]] which summarized current knowledge.		[https://www.ncbi.nlm.nih.gov/pubmed?term=(alaska%5BTitle%5D%20OR%20polar%5BTitle%5D%20OR%20arctic%5BTitle%5D)%20AND%20helicobacter%5BTitle%5D <u>(alaska[Title] OR polar[Title] OR arctic[Title]) AND helicobacter[Title]]</u> returned 29 articles. In June of 2016 researchers from the CDC presented Grand Rounds at YKHC and gave [[media:Hpylori Update.pdf\|<u>this excellent talk</u>]] which summarized current knowledge.



	===International Multi-Disciplinary Working Group===		===International Multi-Disciplinary Working Group===
	In 2016 an international, multi-disciplinary working group, including representatives from the CDC Arctic Research Center and Alaska Native Tribal Health Consortium, published an Expert Commentary<ref name=mcmahon2016>McMahon BJ, Bruce MG, Koch A, et al. The diagnosis and treatment of Helicobacter pylori infection in Arctic regions with a high prevalence of infection: Expert Commentary. Epidemiology and Infection. 2016;144(2):225-233. doi:10.1017/S0950268815001181. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4697284/pdf/S0950268815001181a.pdf '''Free PMC Article'''].</ref> which thoroughly reviews the epidemiology, associated clinical syndromes, diagnosis, and treatment of H. pylori in high prevalence populations. Some of the key findings/recommendations were:		In 2016 an international, multi-disciplinary working group, including representatives from the CDC Arctic Research Center and Alaska Native Tribal Health Consortium, published an Expert Commentary<ref name=mcmahon2016>McMahon BJ, Bruce MG, Koch A, et al. The diagnosis and treatment of Helicobacter pylori infection in Arctic regions with a high prevalence of infection: Expert Commentary. Epidemiology and Infection. 2016;144(2):225-233. doi:10.1017/S0950268815001181. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4697284/pdf/S0950268815001181a.pdf '''Free PMC Article'''].</ref> which thoroughly reviews the epidemiology, associated clinical syndromes, diagnosis, and treatment of H. pylori in high prevalence populations. Some of the key findings/recommendations were:

	* The ''test-and-treat'' strategy (using serology, urea breath test, stool antigen test, other techniques) should ''not'' be used in high prevalence populations (such as in Alaska Natives).		* The ''test-and-treat'' strategy (using serology, urea breath test, stool antigen test, other techniques) should ''not'' be used in high prevalence populations (such as in Alaska Natives).
			* ''"When treatment is employed, treatment should consist of regimens that have evidence of high efficacy after taking into consideration the antimicrobial resistance patterns in the region."''
	* ''"When treatment is employed, treatment should consist of regimens that have evidence of high efficacy after taking into consideration the antimicrobial resistance patterns in the region."
	''

	* Evidence supports treatment of H. pylori only in these situations:		* Evidence supports treatment of H. pylori only in these situations:
	:# Duodenal ulcer		:# Duodenal ulcer
	:# Gastric ulcer		:# Gastric ulcer
	:# MALT lymphoma		:# MALT lymphoma
			* ''"When the goal is treatment of dyspepsia in patients from populations where H. pylori is highly prevalent, there is moderate evidence that H. pylori therapy should be undertaken only when there is endoscopic or histopathological confirmation of a condition associated with improvement following elimination of H. pylori, such as peptic ulcer disease."''
	* ''"When the goal is treatment of dyspepsia in patients from populations where H. pylori is highly prevalent, there is moderate evidence that H. pylori therapy should be undertaken only when there is endoscopic or histopathological confirmation of a condition associated with improvement following elimination of H. pylori, such as peptic ulcer disease."
	''



	Based upon these conclusions, the Working Group proposed the following algorithm for management of dyspepsia in high prevalence (>60%) populations (this includes Alaska Natives):		Based upon these conclusions, the Working Group proposed the following algorithm for management of dyspepsia in high prevalence (>60%) populations (this includes Alaska Natives):


	[[File:IWG Figure-1.jpg\|500px\|border\|center\|Algorithm for management of dyspepsia in regions with high prevalence (>60% population infected) of Helicobacter pylori infection.]]		[[File:IWG Figure-1.jpg\|500px\|border\|center\|Algorithm for management of dyspepsia in regions with high prevalence (>60% population infected) of Helicobacter pylori infection.]]



	===Controversies===		===Controversies===
	Evidence is equivocal regarding treatment of H. pylori in the setting of <u>severe</u> gastritis which is <u>not</u> associated with NSAID or EtOH use.<ref name=mcmahon2016/> Please note that ''severe gastritis'' is an endoscopic diagnosis. Endoscopists may differ in their management of this diagnosis.		Evidence is equivocal regarding treatment of H. pylori in the setting of <u>severe</u> gastritis which is <u>not</u> associated with NSAID or EtOH use.<ref name=mcmahon2016/> Please note that ''severe gastritis'' is an endoscopic diagnosis. Endoscopists may differ in their management of this diagnosis.



	===H. pylori Culture and Sensitivities===		===H. pylori Culture and Sensitivities===
	H. pylori culture with sensitivities (from endoscopic biopsy specimens) is unavailable in most health care settings. Fortunately, the CDC provides this service for rural, high prevalence Alaska communities, and YKHC participates in this program. Results take 1 to 2 months, so a particular patient's results have little utility in treating his/her infection. But population results inform the local <u>[[H. pylori Antibiogram]]</u> which should be utilized when prescribing H. pylori treatment.		H. pylori culture with sensitivities (from endoscopic biopsy specimens) is unavailable in most health care settings. Fortunately, the CDC provides this service for rural, high prevalence Alaska communities, and YKHC participates in this program. Results take 1 to 2 months, so a particular patient's results have little utility in treating his/her infection. But population results inform the local <u>[[H. pylori Antibiogram]]</u> which should be utilized when prescribing H. pylori treatment.



	===Pediatric Considerations===		===Pediatric Considerations===
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	# '''When dyspepsia fails to respond to a PPI, patients should be referred for EGD.'''		# '''When dyspepsia fails to respond to a PPI, patients should be referred for EGD.'''

	==Resources==		===Resources===
	* [[media:Hpylori Update.pdf\|Updates on H. Pylori Research in Alaska 2016]]		* [[media:Hpylori Update.pdf\|Updates on H. Pylori Research in Alaska 2016]]
	* [http://anmc.org/files/CG_HelicobacterPyloriGuideline_010917.pdf <u>ANMC H. pylori guideline</u>]		* [http://anmc.org/files/CG_HelicobacterPyloriGuideline_010917.pdf <u>ANMC H. pylori guideline</u>]

JenniferH: /* Resources */

2020-11-21T13:40:49Z

Resources

← Older revision		Revision as of 13:40, 21 November 2020
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	==Resources==		==Resources==
	* [[media:Hpylori Update.pdf\|Updates on H. Pylori Research in Alaska 2016]]		* [[media:Hpylori Update.pdf\|Updates on H. Pylori Research in Alaska 2016]]
			* [http://anmc.org/files/CG_HelicobacterPyloriGuideline_010917.pdf <u>ANMC H. pylori guideline</u>]
	* [[media:H_pylori_dyspepsia.pdf\|Dyspepsia (H. pylori) YKHC Clinical Guideline]]		* [[media:H_pylori_dyspepsia.pdf\|Dyspepsia (H. pylori) YKHC Clinical Guideline]]

JenniferH: /* YKHC/ANMC Guideline */

2020-11-21T13:40:07Z

YKHC/ANMC Guideline

← Older revision		Revision as of 13:40, 21 November 2020
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	[[File:IWG Figure-1.jpg\|500px\|border\|center\|Algorithm for management of dyspepsia in regions with high prevalence (>60% population infected) of Helicobacter pylori infection.]]		[[File:IWG Figure-1.jpg\|500px\|border\|center\|Algorithm for management of dyspepsia in regions with high prevalence (>60% population infected) of Helicobacter pylori infection.]]



	~~===YKHC/ANMC Guideline===~~
	In September 2017, the YKHC Medical Staff Executive Committee approved a guideline which is consistent with the both the Working Group findings/recommendations and the [http://anmc.org/files/CG_HelicobacterPyloriGuideline_010917.pdf <u>ANMC H. pylori guideline</u>]:



	~~[[File:Guidelines2017 H-pylori.pdf\|800px\|border\|center\|YKHC/ANMC Guideline]]~~

JenniferH: /* Pediatric Considerations */

2020-11-21T13:33:49Z

Pediatric Considerations

← Older revision		Revision as of 13:33, 21 November 2020
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	===Pediatric Considerations===		===Pediatric Considerations===
	~~''Dr Herrmann's input will go here.''~~




	===SUMMARY===		===SUMMARY===

JenniferH: /* Resources */

2020-11-20T13:34:25Z

Resources

← Older revision		Revision as of 13:34, 20 November 2020
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	* [[media:Hpylori Update.pdf\|Updates on H. Pylori Research in Alaska 2016]]		* [[media:Hpylori Update.pdf\|Updates on H. Pylori Research in Alaska 2016]]
	* [[media:H_pylori_dyspepsia.pdf\|Dyspepsia (H. pylori) YKHC Clinical Guideline]]		* [[media:H_pylori_dyspepsia.pdf\|Dyspepsia (H. pylori) YKHC Clinical Guideline]]


			[[:category:YKHC Guidelines\|YKHC Clinical Guidelines]]
			<br/>[[Practicing Medicine in Bush Alaska—Some ABCs\|Common/Unique Medical Diagnoses]]

	===References===		===References===
	----		----

JenniferH: /* References */

2020-11-20T13:33:50Z

References

← Older revision		Revision as of 13:33, 20 November 2020
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	===References===		===References===
	----		----


	~~[[:category:YKHC Guidelines\|YKHC Clinical Guidelines]]~~
	~~<br/>[[Practicing Medicine in Bush Alaska—Some ABCs\|Common/Unique Medical Diagnoses]]~~

JenniferH: /* Resources */

2020-11-20T13:33:23Z

Resources

← Older revision		Revision as of 13:33, 20 November 2020
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	===References===		===References===
	----		----


			[[:category:YKHC Guidelines\|YKHC Clinical Guidelines]]
			<br/>[[Practicing Medicine in Bush Alaska—Some ABCs\|Common/Unique Medical Diagnoses]]