Screening and eradication of <i>Helicobacter pylori f</i>or gastric cancer prevention: Taipei Global Consensus II.

Abstract

To convene a global consensus on <i>Helicobacter pylori</i> (<i>H pylori</i>) screening and eradication strategies for gastric cancer prevention, identify key knowledge gaps and outline future research directions. 32 experts from 12 countries developed and refined consensus statements on <i>H pylori</i> management, using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to assess evidence and the Delphi method to achieve ≥80% agreement. Consensus was achieved on 28 statements. Eradication of <i>H pylori</i>, the primary cause of gastric cancer, reduces the risk of gastric cancer across all age groups, with the greatest risk reduction before the onset of premalignant conditions. <i>H pylori</i> eradication also promotes ulcer healing, prevents ulcer recurrence and reduces the risk of NSAID/aspirin related ulcers. <i>H pylori</i> transmission primarily occurs within families, making family based approaches promising for reducing spread and improving treatment outcomes. <i>H pylori</i> screening should prioritise high risk populations. ¹³C-urea breath test or monoclonal stool antigen tests are preferred. Validated serological testing is a feasible alternative in low prevalence settings when followed by confirmatory non-serological testing. Integrating <i>H pylori</i> screening into existing health programmes may optimise patient adherence and resource utilisation. Empiric eradication treatment, especially bismuth quadruple therapy, is recommended in regions with high <i>H pylori</i> antibiotic resistance for conventional antibiotics. Potassium competitive acid blocker based regimens are alternatives. Confirmatory testing is strongly recommended to ensure <i>H pylori</i> eradication. Endoscopy is suggested for <i>H pylori</i> infected individuals with a high risk of gastric cancer and/or alarm features. <i>H pylori</i> eradication does not increase the risk of reflux oesophageal adenocarcinoma. Long term disruptions to the microbiota and resistome, as well as the environmental impact of increased antibiotic use, warrant further investigation. The development of an <i>H pylori</i> vaccine remains an unmet need, as does the establishment of a risk stratified approach informed by advanced genetic research. <i>H pylori</i> eradication is an effective prevention strategy for gastric cancer that should be offered to all infected adult individuals. Future research should prioritise determining the optimal timing for screening, evaluating long term individual and population outcomes, as well as identifying more precise risk stratification parameters.