2024年美国胃肠病学院幽门螺杆菌感染治疗最新临床实践指南要点解读

doi:10.3969/j.issn.1006-5725.2025.04.001

Abstract

Abstract:

Helicobacter pylori （H.pylori） infection is a prevalent global health issue that can lead to indigestion， peptic ulcer disease， and gastric cancer. With ongoing research advancements， significant progress has been made in the eradication of H.pylori. Based on these important findings from North America， the American College of Gastroenterology （ACG） has released updated clinical practice guideline （CPG）， published in the American Journal of Gastroenterology in September 2024. Compared to previous guidelines， key updates include： increased resistance rates to critical antibiotics used for H.pylori treatment， such as clarithromycin and levofloxacin， which have reduced the efficacy of common treatment regimens containing these antibiotics； and research on novel treatment options for newly diagnosed patients， including new antibiotic alternatives （e.g.， rifampicin） or more potent next?generation gastric acid inhibitors （e.g.， potassium?competitive acid blockers， PCABs）. These updates provide the latest evidence and reference for the clinical management of H.pylori infection.

Key words: helicobacter pylori, infection, management, the American College of Gastroenterology, clinical practice guideline

CLC Number:

R573.1

Xinguo WU,Ruhua ZHENG,Xin CHANG,Chunyan NIU,Fuyu. ZHANG. Interpretation of ACG clinical practice guideline in 2024： treatment of helicobacter pylori infection[J]. The Journal of Practical Medicine, 2025, 41(4): 459-464.

Figures/Tables 5

Tab.1

Tab.2

Tab.3

Tab.4

Tab.5

References 24

1	DE MARTEL C， GEORGES D， BRAY F， et al. Global burden of cancer attributable to infections in 2018： A worldwide incidence analysis［J］. Lancet Glob Health， 2020， 8（2）：e180-190. doi:10.1016/s2214-109x(19)30488-7 doi: 10.1016/s2214-109x(19)30488-7
2	PENNELLI G， GRILLO F， GALUPPINI F， et al. Gastritis： Update on etiological features and histological practical approach［J］. Pathologica， 2020， 112（3）： 153-165. doi:10.32074/1591-951x-163 doi: 10.32074/1591-951x-163
3	CHEY W D， HOWDEN C W， MOSS S F， et al. ACG Clinical Guideline： Treatment of Helicobacter pylori Infection［J］.Am J Gastroenterol， 2024， 119（9）：1730-1753. doi:10.14309/ajg.0000000000002968 doi: 10.14309/ajg.0000000000002968
4	LI Y， CHOI H， LEUNG K， et al. Global prevalence of Helicobacter pylori infection between 1980 and 2022： A systematic review and meta analysis［J］. Lancet Gastroenterol Hepatol， 2023， 8（6）：553-564. doi:10.1016/s2468-1253(23)00070-5 doi: 10.1016/s2468-1253(23)00070-5
5	CHEN Y C， MALFERTHEINER P， YU H T， et al. Global Prevalence of Helicobacter pylori Infection and Incidence of Gastric Cancer Between 1980 and 2022［J］. Gastroenterology， 2024， 166（4）：605-619. doi:10.1053/j.gastro.2023.12.022 doi: 10.1053/j.gastro.2023.12.022
6	MALFERTHEINER P， CAMARGO M C， EL-OMAR E， et al. Helicobacter pylori infection［J］. Nat Rev Dis Primers， 2023， 9（1）：19. doi:10.1038/s41572-023-00431-8 doi: 10.1038/s41572-023-00431-8
7	WECHSLER E V， AHUJA N K， BRENNER D， et al. Up-Front Endoscopy Maximizes Cost-Effectiveness and Cost-Satisfaction in Uninvestigated Dyspepsia［J］. Clin Gastroenterol Hepatol， 2023， 21（9）：2378-2388.e28. doi:10.1016/j.cgh.2023.01.003 doi: 10.1016/j.cgh.2023.01.003
8	SUNG H， FERLAY J， SIEGEL R L， et al. Global Cancer Statistics 2020： GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries［J］. CA Cancer J Clin， 2021， 71（3）：209-249. doi:10.3322/caac.21660 doi: 10.3322/caac.21660
9	ALLEMANI C， MATSUDA T， DI CARLO V， et al. Global surveillance of trends in cancer survival 2000-14 （CONCORD-3）： Analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries［J］. Lancet， 2018， 391（10125）： 1023-1075. doi:10.1016/S0140-6736(17)33326-3 doi: 10.1016/S0140-6736(17)33326-3
10	CHIANG T H， CHANG W J， CHEN S L， et al. Mass eradication of Helicobacter pylori to reduce gastric cancer incidence and mortality： A long-term cohort study on Matsu Islands［J］. Gut， 2021， 70（2）：243-250.
11	RUGGE M， BRICCA L， GUZZINATI S， et al. Autoimmune gastritis： Long-term natural history in naive Helicobacter pylori-negative patients［J］. Gut， 2023， 72（1）：30-38. doi:10.1136/gutjnl-2022-327827 doi: 10.1136/gutjnl-2022-327827
12	SAVOLDI A， CARRARA E， GRAHAM D Y， et al. Prevalence of antibiotic resistance in Helicobacter pylori： A systematic review and meta-analysis in World Health Organization regions［J］. Gastroenterology， 2018， 155（5）： 1372-1382.e17. doi:10.1053/j.gastro.2018.07.007 doi: 10.1053/j.gastro.2018.07.007
13	HO J J C， NAVARRO M， SAWYER K， et al. Helicobacter pylori antibiotic resistance in the United States between 2011 and 2021： A systematic review and meta-analysis［J］. Am J Gastroenterol， 2022， 117（8）：1221-1230. doi:10.14309/ajg.0000000000001828 doi: 10.14309/ajg.0000000000001828
14	ZANICHELLI V， SHARLAND M， CAPPELLO B， et al. The WHO AWaRe （Access， Watch， Reserve） antibiotic book and prevention of antimicrobial resistance［J］. Bull World Health Organ， 2023， 101（4）：290-296. doi:10.2471/blt.22.288614 doi: 10.2471/blt.22.288614
15	FERNANDEZ-CASO B， MIQUELEIZ A， ALARCON T. Whole genome sequencing for studying Helicobacter pylori antimicrobial resistance［J］. Antibiotics （Basel）， 2023， 12（7）：1135. doi:10.3390/antibiotics12071135 doi: 10.3390/antibiotics12071135
16	TANAKA S， GOTO A， YAMAGISHI K， et al. Long-term Response of Helicobacter pylori Antibody Titer After Eradication Treatment in Middle-aged Japanese： JPHC-NEXT Study［J］. J Epidemiol， 2023， 33（1）：1-7. doi:10.2188/jea.je20200618 doi: 10.2188/jea.je20200618
17	HONG T C， EL-OMAR E M， KUO Y T， et al. Asian Pacific Alliance on Helicobacter and Microbiota. Primary antibiotic resistance of Helicobacter pylori in the Asia-Pacific region between 1990 and 2022： An updated systematic review and meta-analysis［J］. Lancet Gastroenterol Hepatol， 2024， 9（1）：56-67. doi:10.1016/s2468-1253(23)00281-9 doi: 10.1016/s2468-1253(23)00281-9
18	RAUT S， ADHIKARI B. Global leadership against antimicrobial resistance ought to include developing countries［J］. Lancet Infect Dis， 2016， 16（7）：775. doi:10.1016/s1473-3099(16)30078-0 doi: 10.1016/s1473-3099(16)30078-0
19	ZAGARI R M， DAJTI E， COMINARDI A， et al. Standard bismuth quadruple therapy versus concomitant therapy for the first-line treatment of Helicobacter pylori infection： A systematic review and meta-analysis of randomized controlled trials［J］. J Clin Med， 2023， 12（9）：3258. doi:10.3390/jcm12093258 doi: 10.3390/jcm12093258
20	GRAHAM D Y， CANAAN Y， MAHER J， et al. Rifabutin-based triple therapy （RHB-105） for Helicobacter pylori eradication： A double-blind， randomized， controlled trial［J］. Ann Intern Med， 2020， 172（12）：795-802. doi:10.7326/m19-3734 doi: 10.7326/m19-3734
21	LAINE L， SHARMA P， MULFORD D J， et al. Pharmacodynamics and pharmacokinetics of the potassium-competitive acid blocker vonoprazan and the proton pump inhibitor lansoprazole in US subjects［J］. Am J Gastroenterol， 2022， 117（7）：1158-1161. doi:10.14309/ajg.0000000000001735 doi: 10.14309/ajg.0000000000001735
22	PATEL A， LAINE L， MOAYYEDI P， et al. AGA Clinical Practice Update on Integrating Potassium-Competitive Acid Blockers Into Clinical Practice： Expert Review［J］. Gastroenterology， 2024， 167（6）：1228-1238. doi:10.1053/j.gastro.2024.06.038 doi: 10.1053/j.gastro.2024.06.038
23	YAN T L， WANG J H， HE X J， et al. Ten-day vonoprazan-amoxicillin dual therapy vs standard 14-day bismuth-based quadruple therapy for firstline Helicobacter pylori eradication： A multicenter randomized clinical trial［J］. Am J Gastroenterol， 2024， 119（4）：655-661. doi:10.14309/ajg.0000000000002592 doi: 10.14309/ajg.0000000000002592
24	CHEY W D， MEGRAUD F， LAINE L， et al. Vonoprazan triple and dual therapy for Helicobacter pylori infection in the United States and Europe： Randomized clinical trial［J］. Gastroenterology， 2022， 163（3）：608-619. doi:10.1053/j.gastro.2022.05.055 doi: 10.1053/j.gastro.2022.05.055

类别	方案	药物（剂量）	给药频次
推荐的H.pylori感染一线初始治疗方案（疗程均为14 d）	优化BQT	PPI（标准剂量）	b.i.d
		枸橼酸铋（120 ~ 300 mg）或次水杨酸盐（300 mg）	q.i.d
		四环素（500 mg）	q.i.d
		甲硝唑（500 mg）	t.i.d或q.i.d
	利福布汀三联	奥美拉唑（10 mg）	4粒 t.i.d
		阿莫西林（250 mg）	4粒 t.i.d
		RBT（12.5 mg）	4粒 t.i.d
	PCAB二联	伏诺拉生（20mg）	b.i.d
		阿莫西林（1 000 mg）	t.i.d
	PCAB三联	伏诺拉生（20 mg）	b.i.d
		克拉霉素（500 mg）	b.i.d
		阿莫西林（1 000 mg）	b.i.d

条件	方案
无青霉素过敏	优化BQT
	RBT三联
	PCAB二联
	PCAB-克拉霉素三联^*
青霉素过敏方正汇总行^**	优化BQT

方案	药物（剂量）	给药频次	是否需要AST
优化BQT	PPI（标准剂量）	b.i.d	否
	枸橼酸铋（120 ~ 300 mg）或次水杨酸盐（300 mg）	q.i.d
	四环素（500 mg）	q.i.d
	甲硝唑（500 mg）	t.i.d或q.i.d
利福布汀三联	PPI（标准剂量→双倍剂量）	b.i.d	否
	阿莫西林（1 000 mg）	b.i.d或t.i.d
	RBT（50 ~ 300 mg）	q.d或b.i.d
左氧氟沙星三联	PPI（标准剂量）	b.i.d	是
	左氧氟沙星（500 mg）	q.d
	阿莫西林（1 000 mg）或甲硝唑（500 mg）	b.i.d
PCAB三联	伏诺拉生（20 mg）	b.i.d	是
	克拉霉素（500 mg）	b.i.d
	阿莫西林（1 000 mg）	b.i.d
高剂量二联	伏诺拉生（20 mg）或PPI（双倍剂量）	b.i.d或t.i.d	否
	阿莫西林（1 000 mg）	t.i.d	否

是否有AST	条件	方案
无AST	既往接受过PPI-克拉霉素三联治疗及/或既往未接受过优化BQT治疗	（无青霉素过敏）优化BQT
		（无青霉素过敏）RBT三联
		（无青霉素过敏）高剂量PPI或PCAB二联^*
		（青霉素过敏**）优化BQT
有AST	克拉霉素和左氧氟沙星敏感	克拉霉素三联^***
		优化BQT
		RBT三联
		左氧氟沙星三联
	克拉霉素耐药,左氧氟沙星敏感	优化BQT
		RBT三联
		左氧氟沙星三联
	克拉霉素敏感,左氧氟沙星耐药	克拉霉素三联
		优化BQT
		RBT三联
	克拉霉素及左氧氟沙星均耐药	优化BQT
		RBT三联
		高剂量PPI或PCAB二联

[1]	Wenfang HE,Xun ZHOU,Meizhu DING,Yiping CHEN,Qianli LIU,Xinyuan. TAN. Application of the "ASK⁃T" aspiration prevention management model in reducing the risk of aspiration in elderly patients with chronic obstructive pulmonary disease （COPD） complicated by dysphagia [J]. The Journal of Practical Medicine, 2025, 41(3): 434-441.
[2]	Dandan SHANG,Ping LIU,Lizhen LIU,Yiwei PANG,Chao ZHOU. Diagnosis and advances in individualized management of resistant ovary syndrome and premature ovarian insufficiency [J]. The Journal of Practical Medicine, 2025, 41(1): 146-152.
[3]	Xi LIU,Xiaona LIU,Chao LI,Rui XIAN,Lihong CUI. Efficacy analysis of different regimens for treatment of Helicobacter pylori infection combined with small intestinal bacterial overgrowth [J]. The Journal of Practical Medicine, 2024, 40(9): 1303-1308.
[4]	Peng. LIANG. The role of anesthesiologists in the whole⁃process management of day surgery [J]. The Journal of Practical Medicine, 2024, 40(8): 1031-1037.
[5]	Yue QIAN,Zhengliang. MA. Anesthesia and perioperative quality control of ambulatory surgery under the concept of rapid recovery surgery [J]. The Journal of Practical Medicine, 2024, 40(8): 1042-1046.
[6]	Shuangyan LI,Bin ZHANG. Research status and challenges of insomnia disorder [J]. The Journal of Practical Medicine, 2024, 40(6): 731-737.
[7]	Changzhi GUO,Tao SUN,Shuman HAN,Lingxiang WANG,Mengjing. NIU. Risk factors of peripheral infections of knee joint tumor prosthesis and predictive value of serum D⁃dimer and TLR2 [J]. The Journal of Practical Medicine, 2024, 40(6): 814-819.
[8]	Sibo LONG,Yan CHEN,Xintong ZHANG,Yanjun YIN,Limei YANG,Maike ZHENG,Chaohong WANG,Qing SUN,Jun YAN,Yiheng SHI,Guangli SHI,Yan ZHAO,Guirong. WANG. Serum levels of procalcitonin， interleukin⁃6 and interleukin⁃8 in patients with COVID⁃19 infection at admission and their significance in patient prognosis [J]. The Journal of Practical Medicine, 2024, 40(4): 471-475.
[9]	Defeng SUN. Standardized management strategy of anesthesia for Day Surgery [J]. The Journal of Practical Medicine, 2024, 40(3): 283-288.
[10]	Na LI,Yihua BAI,Hongying JIANG,Feng ZHANG,Meng LI,Jiao YANG. Frailty of patients with long⁃term maintenance dialysis and its influencing factors [J]. The Journal of Practical Medicine, 2024, 40(3): 330-335.
[11]	Min LI,Hongqiang ZHAO,Bin CAO,Lili LIU,Yuzhen BAO,Fengyong. YANG. Logistic regression versus CART decision tree model for predicting pulmonary infection in elderly patients with heart failure with reduced left ventricular ejection fraction [J]. The Journal of Practical Medicine, 2024, 40(23): 3349-3355.
[12]	Huiling YE,Renming. ZHONG. Progress in assessing the treatment accuracy of liver stereotactic body radiotherapy through post-therapeutic magnetic resonance imaging morphologic alterations [J]. The Journal of Practical Medicine, 2024, 40(22): 3119-3123.
[13]	Kunyuan HUANG,Kehua JIANG,Qing WANG. Research progress of S100A9 in renal diseases [J]. The Journal of Practical Medicine, 2024, 40(22): 3251-3255.
[14]	Chao SHENG,Zhijian. WANG. Early identification， standardized diagnosis and treatment of placenta accreta spectrum disorders [J]. The Journal of Practical Medicine, 2024, 40(21): 2965-2970.
[15]	Yimei HUANG,Lulu ZHAO,Baotong. HUA. Application effect of insertable cardiac monitorin atrial fibrillation monitoring [J]. The Journal of Practical Medicine, 2024, 40(21): 3095-3100.

Interpretation of ACG clinical practice guideline in 2024： treatment of helicobacter pylori infection

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 5

References 24

Related Articles 15

Recommended Articles

Metrics

Comments

1. 消化性溃疡：既往有溃疡病史或溃疡活动期
2. MALT淋巴瘤
3. 60岁以下未经检查的消化不良
（1）在胃癌高风险人群中，在45 ~ 50岁时进行检测和治疗
4. 功能性消化不良
5. 成年家庭成员中非血清学检测H.pylori阳性者
6. 长期服用非甾体抗炎药或开始长期低剂量阿司匹林治疗者
7. 原因不明的缺铁性贫血
8. 特发性(自身免疫性)血小板减少性紫癜
9. 胃腺癌的一级和二级预防
（1）当前或既往有胃癌前病变（GPMC）
（2）当前或既往有早期胃癌切除史
（3）当前或既往有胃腺癌病史
（4）有胃腺瘤或增生性息肉的患者
（5）一级亲属中有胃癌患者
（6）胃癌风险增加者
（7）自身免疫性胃炎