What are the Canadian Association of Gastroenterology (CAG) guidelines for H pylori eradication to prevent gastric cancer?

Updated: Feb 23, 2021
  • Author: Elwyn C Cabebe, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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The 2016 Canadian Association of Gastroenterology (CAG) consensus guidelines took note of the growing prevalence of antibiotic-resistant strains of H pylori and the increased failure of PPI triple therapies (a PPI plus two of the following antibiotics: clarithromycin, amoxicillin, or metronidazole) for 7 to 10 days as first-line therapy. In response, the guidelines gave a strong recommendation to a treatment duration of 14 days with the choice of first-line therapy based on local antibiotic resistance patterns and eradication rates.First-line therapy options include [70] :

  • Bismuth quadruple therapy (PPI, bismuth, metronidazol, and tetracycline)
  • Nonbismuth quadruple therapy (PPI, amoxicillin, metronidazole, and clarithromycin)
  • PPI triple therapy only in areas with low clarithromycin resistance (< 15%) or proven high local eradication rates (>85%)

In addition, the CAG guidelines recommended against the following therapies [70] :

  • Levofloxacin triple therapy (PPI, amoxicillin levofloxacin)
  • Sequential nonbismuth quadruple therapy (PPI and amoxicillin followed by PPI, metronidazole and clarithromycin)
  • The addition of probiotics to eradication therapy for the purpose of reducing adverse events or increasing eradication rates

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