The New AGA Dyspepsia Guideline

1
The New AGA Dyspepsia Guideline
Adapted from Talley et al. Gastroenterology.
20051291753-1755
2
U.S. Prevalence of H. pylori
African American Hispanic White
100
80
60
Prevalence of H. pylori ()
40
20
0
0
20
40
80
60
Age (years)
Adapted from H. pylori and Peptic Ulcer.
Bethesda, MD National Digestive Diseases
Information Clearinghouse 1997. NIH publication
97-4225
3
H pylori Disease Progression

• Chronic, active, antral gastritis
• Duodenal ulcer risk ?
• Acid secretion ?

H. pylori Infection

• Chronic, active, corpus gastritis
• Gastric ulcer risk ?
• Acid secretion ?

• Chronic, atrophic pangastritis with severe
  atrophy and intestinal metaplasia
• Gastric cancer risk ?

Superficial Gastritis
Normal
Adapted from Labenz. Am J Gastroenterol.
199994867-869
4
Primary Therapy for H. pylori
Adapted from Chey and Wong. Am J Gastroenterol.
20071021808
5
Triple vs. Quadruple Therapy for H.
pylori Infection A Meta-analysis
Percent
8 RCTS N1,585
Adapted from Luther et al. Am J Gastroenterol.
2008103S397
6
Effect of Antibiotic Resistance on the Efficacy
of First-line H. pylori Therapies
Eradication rate modified ITT ()
P.004 vs. OBMT
OBMT (quadruple therapy n138) OAC (triple
therapy n137)

Adapted from Laine et al. Am J Gastroenterol.
200398562
7
What is Sequential Therapy?
Adapted from Zullo et al. Aliment Pharmacol Ther.
200317719
8
Meta-analysis of Sequential vs. Triple Therapy
for H. pylori

• 10 RCTs
• Publication bias, only 1 DB, most Italian

Sequential Rxn2,747 Triple Rxn1,363
Adapted from Jafri et al. Ann Int Med. 2008148