off record
Shaukat Ali Jawaid


Treatment of H. Pylori:
Need for local Guidelines


One of the important functions of any professional specialty organization is to organize Continuing Medical Education programmes, Training courses and Workshops for its members to keep them update with latest developments in their respective specialty.  In addition they are also expected to monitor their members, ensure ethical practice and come up with Guidelines for treatment of different diseases within their respective disciplines after consensus meetings among its members after doing proper studies and surveys.

During the recently held 33rd Annual Congress of Pakistan Society of Gastroenterology and G.I. Endoscopy Prof. Varocha Mahachai from Bangkok Thailand presented an Update on Treatment of H. Pylori and ASEAN Guidelines. When asked do we have any such Guidelines and if not, don’t they feel the need to have such Guidelines because in this particular area since these guidelines are dependent on the local resistance and sensitivity pattern to various available antimicrobial agents, Prof. Shahab Abid Chairman of the Scientific Committee informed that no such local guidelines exist? However, he agreed that it was important to have such guidelines and they have asked Prof. Masood Siddique who is going to take over as the new President of PSG and GI Endoscopy to take it up as a priority issue. He further stated that working on this will start soon and PSG will come up with its own guidelines soon.

One wonders why the PSG leadership so far did not give it importance and prepared the guidelines.  As a result of irrational use of antimicrobial agents, many conventional antibiotics as well as second and third line antimicrobials have developed high resistance. We have no proper survey to know the prevalence of H. Pylori and as per different hospital bases studies, the prevalence is reported to be about 50% or so. Hence, it is extremely important that we should know the sensitivity and resistance pattern to various antibiotics so that effective antibiotics can be used to treat this infection. Unlike Hypertension and Diabetes and few other diseases, Guidelines by institutions, professional specialty organizations from overseas cannot be used for eradication of H. Pylori, hence the need for local guidelines.

Dr. Varocha Mahachai in her presentation did point out that they had formed different groups which looked into epidemiology, diagnostic tests, Treatment and treatment follow up. They felt that Urease Breath Test (UBT) was the best option to assess for H. Pylori eradication and test should be done four weeks after discontinuation of therapy. Treatment is based on local antibiotic resistance pattern. Susceptibility testing should be done after failure of two treatments and rescue therapy should be based on susceptibility testing. Triple therapy is often used but in some cases, one may have to use four antibiotics.  Metronidazole is an economically priced drug which is easily available everywhere and is always included in this combination. However, in view of resistance one may have to use it for longer periods in a rather higher dose.

As stated by Prof. Shahab Abid, one hopes that the new PSG leadership will call a meeting shortly and take up development of local Guidelines for Treatment of H. Pylori on urgent basis.

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