臨牀消化器内科 Vol.20 No.1(6)


特集名 Helicobacter pylori update
題名 ヘリコバクター学会改訂ガイドラインはどこが変わったのか
発刊年月 2005年 01月
著者 加藤 元嗣 北海道大学光学医療診療部
著者 中川 宗一 北海道大学光学医療診療部
著者 清水 勇一 北海道大学光学医療診療部
著者 森 康明 北海道大学消化器内科
著者 小野 尚子 北海道大学消化器内科
著者 小野 雄司 北海道大学消化器内科
著者 中川 学 北海道大学消化器内科
著者 山本 純司 北海道大学消化器内科
著者 浅香 正博 北海道大学消化器内科
【 要旨 】 日本ヘリコバクター学会は，実地医家を対象にしたHelicobacter pylori (H. pylori) 感染の診断と治療のガイドライン2003年改訂版を作成した．適応疾患については，旧ガイドラインに比べ一歩踏み込んだものとなった．H. pylori除菌治療が勧められる疾患として胃潰瘍・十二指腸潰瘍と胃MALTリンパ腫が掲げられ，H. pylori除菌治療が望ましい疾患に，早期胃癌に対する内視鏡的粘膜切除術 (EMR) 術後胃，萎縮性胃炎，胃過形成性ポリープが加わった．感染診断では，便中H. pylori抗原測定法が新たに診断法として追加された．また，除菌治療ではオメプラゾールを用いた3剤併用療法がレジメとして加わった．
Theme Helicobacter pylori update
Title The Revision of Guidelines for Diagnosis and the Treatment of Helicobacter pylori Infection
Author Mototsugu Kato Division of Endoscopy, Hokkaido University Hospital
Author Souichi Nakagawa Division of Endoscopy, Hokkaido University Hospital
Author Yuichi Shimizu Division of Endoscopy, Hokkaido University Hospital
Author Yasuaki Mori Department of Gastroenterology, Hokkaido University Graduate School of Medicine
Author Shouko Ono Department of Gastroenterology, Hokkaido University Graduate School of Medicine
Author Yuji Ono Department of Gastroenterology, Hokkaido University Graduate School of Medicine
Author Manabu Nakagawa Department of Gastroenterology, Hokkaido University Graduate School of Medicine
Author Junji Yamamoto Department of Gastroenterology, Hokkaido University Graduate School of Medicine
Author Masahiro Asaka Department of Gastroenterology, Hokkaido University Graduate School of Medicine
[ Summary ] The Japanese Society for Helicobacter Research established the second version of guidelines for diagnosis and the treatment of Helicobacter pylori (H. pylori) infection in 2003. The first version guidelines, established in 2000, have gradually become unsuitable to the current clinical management of H. pylori. The most strongly recommended indications for H. pylori eradication, in the new guidelines include gastric ulcers, duodenal ulcers, and gastric MALT lymphoma. Gastric MALT lymphoma was newly added to there strongly recommended indications. Post endoscopic resection of gastric cancer, atrophic gastritis, and hyperplastic polyps were chosen as advisable indications under new categories in the new guidelines. Rapid urease tests, histological examination, cultures, urea breath test and blood antibody tests were indicated before and after eradication treatment in previous guidelines. The stool antigen test was admitted as an indicated diagnostic method for H. pylori infection. The basic regimen for firstline eradication treatment was a one week course of proton pump inhibitors (PPI), for based triple therapy. Omeprazole based triple therapy was additionally recommended in the new guidelines. A triple therapy including PPI, metronidazole and amoxicillin was recommended as back-up therapy after failure of first line therapy because clarithromycin resistant strains were the main reason for unsuccessful H. pylori eradication.
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