Guidelines in the management of Helicobacter pylori infection in Japan

Background. In preparation of the approval of Helicobacter pylori therapy b y the Japanese national health system, the board of directors of the Japane se Society for Helicobacter Research decided to prepare guidelines on the d iagnosis and treatment of H. pylori infection for physicians in routine med ical practice. Methods. A guidelines preparation committee was formed and six meetings wer e held. Then, in December 1999, a consensus meeting was held in Kobe to obt ain the opinions of general practitioners as well as experts from Europe, N orth America, and Asia. Results. Helicobacter pylori eradication therapy is recommended in gastric or duodenal ulcer patients. Helicobacter pylori eradication therapy is reco mmended or gastric mucosa associated lymphoid tissue (MALT) lymphoma but it should be done at specialist institutions. The significance of H. pylori e radication therapy is still under evaluation in patients with hyperplastic polyps, chronic atrophic gastritis, non-ulcer dyspepsia and in patients aft er endoscopic mucosal resection of gastric cancer and after gastrectomy for gastric cancer. When diagnosing H. pylori infection, at least one of the t ests requiring endoscopic biopsy (e.g. rapid urease test, histology, or cul ture) and tests not requiring biopsy (e.g. measurement of H. pylori antibod y or urea breath test) should be used. Multiple tests are recommended to in crease the accuracy. The drugs of first choice currently covered by the nat ional health insurance system in Japan are: lansoprazole (30 mg) 1 capsule twice daily, amoxicillin (250 mg) 3 capsules tv. ice daily, and clarithromy cin (200 mg) 1-2 tablets twice daily. These three drugs should be administe red after breakfast and dinner for 1 week. Conclusion. These guidelines are intended for utilization in routine medica l practice after the Japanese national health system begins to cover the ma nagement of H. pylori infection.