First-Line Treatment for Environmental Metaplastic Atrophic Gastritis with Active H. pylori Infection (Treatment-Naive Patients)
This protocol addresses environmental metaplastic atrophic gastritis (ICD-11 DA42.1 / ICD-10 K29.4) in the specific clinical situation of active Helicobacter pylori infection confirmed by a nonserological test in patients who are treatment-naive and have no penicillin allergy.
- Active H. pylori infection confirmed by a nonserological test
- No previous H. pylori eradication therapy (treatment-naive)
- No penicillin allergy
First-line empiric eradication therapy for 14 days is indicated; optimized bismuth quadruple therapy (BQT) is the preferred regimen, and additional options are available for treatment-naive patients without penicillin allergy. The complete regimen, alternatives, and dosing are in the full protocol.
Confirmed eradication of H. pylori by test of cure — urea breath test, fecal antigen test, or biopsy-based test — performed at least 4 weeks after completing therapy.
DOI: 10.14309/ajg.0000000000002968
- We summarize treatment recommendations for patients with active H. pylori infection, as confirmed by a nonserological test, who have not been previously treated (i.e., "treatment-naive" patients) and those with persistent infection despite previous attempt(s) at eradication (i.e., "treatment-experienced" patients).
- Of the recommended and suggested options for treatment-naive patients, only optimized BQT is suitable for patients with a true penicillin allergy.
- In treatment-naive patients with H. pylori infection, optimized BQT is recommended as a first-line treatment option (strong recommendation; moderate quality evidence).
- Recommended regimens for treatment-naive patients with H. pylori infection (All regimens are recommended for 14 days.).
- All patients who are treated for H. pylori infection should undergo a test of cure with an appropriately conducted urea breath test, fecal antigen test, or biopsy-based test at least 4 weeks after completion of therapy.