Guía de práctica clínica
V Conferencia Española de Consenso sobre el tratamiento de la infección por Helicobacter pyloriV Spanish Consensus Conference on Helicobacter pylori infection treatment

https://doi.org/10.1016/j.gastrohep.2021.07.011Get rights and content

Resumen

La infección por Helicobacter pylori es muy frecuente entre la población española y representa la causa fundamental de gastritis crónica, úlcera péptica y cáncer gástrico. Previamente se han llevado a cabo cuatro reuniones de Consenso sobre el manejo de la infección por H. pylori en España, la última de ellas en 2016. Los cambios en los esquemas de tratamiento y la creciente evidencia disponible al respecto han justificado la organización de esta V Conferencia Española de Consenso en mayo de 2021, centrada en el tratamiento de esta infección. Participaron 14 expertos sobre el tema, que realizaron una búsqueda sistemática de la evidencia científica y elaboraron una serie de recomendaciones que fueron sometidas a un proceso de interacción de votaciones anónimas seriadas mediante metodología Delphi. Para clasificar la evidencia científica y la fuerza de las recomendaciones, se utilizó el sistema GRADE. Este consenso establece, como punto de partida, un aumento de la exigencia en la eficacia de los tratamientos recomendados, que deben alcanzar, o preferiblemente superar, el 90% de curación al ser administrados empíricamente. De este modo, tanto en primera como en segunda línea se recomiendan tratamientos cuádruples con o sin bismuto, generalmente prescritos durante 14 días. Como tratamiento de primera línea se recomienda una pauta cuádruple concomitante sin bismuto (inhibidor de la bomba de protones, claritromicina, amoxicilina y metronidazol) o una combinación cuádruple con bismuto (inhibidor de la bomba de protones, bismuto, tetraciclina y metronidazol). En el presente consenso se revisan también con detalle otras alternativas de tratamiento de rescate.

Abstract

Helicobacter pylori infection is very common in the Spanish population and represents the main cause of chronic gastritis, peptic ulcer, and gastric cancer. The last iteration of Spanish consensus guidelines on H. pylori infection was conducted in 2016. Recent changes in therapeutic schemes along with increasing supporting evidence were key for developing the V Spanish Consensus Conference (May 2021). Fourteen experts performed a systematic review of the scientific evidence and developed a series of recommendations that were subjected to an anonymous Delphi process of iterative voting. Scientific evidence and the strength of the recommendation were classified using GRADE guidelines. An eradication therapy, when prescribed empirically, is considered acceptable when it reliably achieves, or preferably surpass, 90% cure rates. Currently, only quadruple therapies (with or without bismuth) and generally lasting 14 days, accomplish this goal in first- and second-line therapies. A non-bismuth quadruple concomitant regimen (proton pump inhibitor, clarithromycin, amoxicillin, and metronidazole) or a quadruple bismuth-based combination (proton pump inhibitor, bismuth, tetracycline, and metronidazole), are recommended as first-line regimens. Rescue therapies after eradication failure and management of H. pylori infection in peptic ulcer disease were also reviewed.

Section snippets

Introducción

La infección por Helicobacter pylori (H. pylori) afecta a alrededor del 50% de la población mundial y desempeña un papel fundamental en el desarrollo de diversas enfermedades digestivas como la gastritis crónica, la úlcera péptica y el cáncer gástrico, por lo que un diagnóstico adecuado y un tratamiento eficaz son esenciales en la práctica clínica. En España, se han organizado hasta la fecha cuatro reuniones de consenso sobre la infección por H. pylori: en 19991, 2, 20043, 4, 20125 y, la

Metodología

Participantes en el consenso: se invitó a participar a los investigadores españoles que durante los últimos 5 años hubieran publicado al menos 5 artículos sobre el tratamiento de la infección por H. pylori, identificados mediante la estrategia de búsqueda «Helicobacter pylori AND Spain» en PubMed. En total, 14 expertos fueron invitados, y todos ellos aceptaron, incluyendo gastroenterólogos, médicos de Atención Primaria y expertos en metodología científica y medicina basada en la evidencia. Un

Recomendaciones

Cada recomendación se acompaña del resultado de la votación (porcentaje de acuerdo), el grado de recomendación (GR; fuerte o débil), la calidad de la evidencia (CE; alta, moderada, baja o muy baja) y de la discusión de la evidencia correspondiente.

Todas las recomendaciones aprobadas en el presente consenso español sobre el tratamiento de la infección por H. pylori se incluyen en la tabla 1. Los fármacos, la duración y la dosis de cada uno de los componentes de las pautas recomendadas se

Conflicto de intereses

J. Alcedo, J. Amador, L. Bujanda, X. Calvet, M. Castro-Fernández, E. Gené, A. Lanas, A.J. Lucendo, J. Molina-Infante, A. Pérez-Aisa e I. Puig declaran no tener ningún conflicto de intereses.

L. Fernández-Salazar actividad docente: Janssen, Norgine, Salvat, Tillots.

J.P. Gisbert asesoramiento científico, soporte para investigación o actividades formativas: Mayoly, Allergan, Diasorin, Gebro Pharma, Richen.

O.P. Nyssen soporte para investigación: Mayoly, Allergan.

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    Este documento se publica simultáneamente en las revistas Gastroenterología y Hepatología – [https://doi.org/10.1016/j.gastrohep.2021.07.011] y Revista Española de Enfermedades Digestivas – [https://doi.org/10.17235/reed.2021.8358/2021], con el consentimiento de los autores y editores.

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