Optimized diagnosis of Helicobacter pylori and tailored eradication therapy for preventing gastric cancer: a proposal for SHAKE strategy

ABSTRACT

Introduction

To decrease gastric cancer-related mortality, the Korean National Cancer Screening Program provides biennial screening gastroscopy to all individuals aged >40 years. However, a test-and-treat strategy of Helicobacter pylori for preventing gastric cancer has not been established.

Areas covered

In this review, we present up-to-date results of endoscopic findings of H. pylori gastritis, optimal sites for H. pylori detection, gastric cancer risk assessment using serum pepsinogen, tailored eradication based on the antimicrobial resistance against H. pylori, and post-eradication surveillance.

Expert opinion

Here we propose approaches to H. pylori diagnosis and treatment for preventing gastric cancer, termed ‘Screening for H. pylori in Korea and Eradication (SHAKE)’ strategy. This strategy consists of the following: (1) optimized H. pylori diagnosis, (2) individualized management based on the H. pylori infection status, and (3) tailored eradication therapy. H. pylori gastritis can be diagnosed by endoscopic observation of the gastric mucosal pattern at the greater curvature of the corpus. Measurement of the serum pepsinogen I/II ratio is useful for assessing the risk of gastric cancer. As a first-line treatment, tailored eradication based on the results of molecular testing is effective in a country with a high rate of clarithromycin-resistant H. pylori.

KEYWORDS:

• Helicobacter pylori
• endoscopy
• diagnosis
• pepsinogen
• eradication
• strategy

Article highlights

• Helicobacter pylori (H. pylori) is a major pathogen in gastric carcinogenesis. Based on the ‘point of no return’ theory, H. pylori eradication does not eliminate the risk of gastric cancer in subjects with gastric atrophy and intestinal metaplasia.

• To decrease gastric cancer-related mortality, the Korean National Cancer Screening Program provides biennial screening gastroscopy to all individuals aged >40 years. However, endoscopic screening alone cannot prevent gastric cancer. H. pylori eradication strategy for preventing gastric cancer has not been introduced to Korea.

• During endoscopy, H. pylori infection status can be predicted by close observation of gastric mucosal pattern at the greater curvature of the corpus.

• Combined with measurement of the serum pepsinogen level, screening endoscopy can identify the optimal timing for, and the subjects who would benefit most from, H. pylori treatment.

• Tailored eradication based on molecular testing of antibiotic resistance is linked to successful H. pylori treatment.

• Herein, a ‘Screening for H. pylori in Korea and Eradication (SHAKE)’ strategy is proposed for optimized H. pylori diagnosis during endoscopy and tailored eradication therapy for preventing gastric cancer.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by the Soonchunhyang University Research Fund.