UBT was the best option to assess for H. Pylori eradication-Varocha Mahachai

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 ASEAN Consensus on H. Pylori Management

UBT was the best option to assess for
H. Pylori eradication-Varocha Mahachai

Susceptibility testing should be done after failure of two treatments
and rescue therapy should be based on susceptibility testing

KARACHI: Dr. Varocha Mahachai from Bangkok Thailand presented Updates on Treatment of H. Pylori and ASEAN Guidelines at one of the sessions during the morning session on March 11th at the 33rd Annual Conference of Pakistan Society of Gastroenterology and GI Endoscopy held here recently.  She pointed out that they had formed different groups on Epidemiology, Diagnostic Tests, Treatment and Treatment Follow up to come up with the recommendations for these guidelines. Not many countries, she said, have facilities for molecular tests. UBT machines were used in the survey.  She discussed at length about Urease Breath Test and biopsy for patients undergoing gastroscopy.

Continuing Dr. Mahachai said that PPIs should be discontinued two weeks before doing test. H. Pylori should be tested and treated in patients who need treatment with NSAIDs for long time. UBT, she opined was the best option to assess for H. Pylori eradication. Speaking about treatment of H. Pylori, she said it will be different in Pakistan because it is based on local antibiotics resistance. Most therapies should be given for fourteen days. Second line drugs has included those antimicrobials which are not used previously. Susceptibility testing should be done after failure of two treatments and rescue therapy should be based on susceptibility testing.  Metronidazole is economically priced available everywhere but in view of resistance, it needs to be used in a higher dose for longer period. Local pattern of susceptibility is extremely important.

During the discussion it was pointed out that some hospital based studies have showed that the prevalence of H. Pylori was 55%. There are some very high prevalence areas and Pakistan Society of Gastroenterology and GI Endoscopy is planning to have a meeting to chalk out future strategy and come with its own guidelines on treatment of H. Pylori in Pakistan.

Gastric Cancer

One of the delegates from Japan talked about Gastric Cancer screening by Barium. He pointed out that there were over thirty thousand members in their Gastroenterology Society and there is a high disease prevalence. Patients have easy access to endoscopy.  He then showed some slides of early endoscopic appearance of gastric cancer. Development of good quality endoscope system, he stated,  has made things quite easy for the endoscopists. It is not always easy to differentiate between benign and malignant cases. Korea and Japan have almost similar mortality from gastric cancer. Treatment is based on e learning system. It is emphasized as to what findings should be detected.  ESD shows high resection rate. The conclusions from this presentation was that early detection, accurate diagnosis and complete endoscopic resection of gastric cancer is important. We organize gastric cancer screening workshops and Endoscopy Hands on seminars, workshops quite frequently, he added.

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