RESUMO
INTRODUCTION: Gastric cancer (GC) is the first cause of cancer-related death in Chile and 6th in Latin America and the Caribbean (LAC). Helicobacter pylori (H. pylori) is the main gastric carcinogen, and its treatment reduces GC incidence and mortality. Esophageal-gastro-duodenoscopy (EGD) allows for the detection of premalignant conditions and early-stage GC. Mass screening programs for H. pylori infection and screening for premalignant conditions and early-stage GC are not currently implemented in LAC. The aim of this study is to establish recommendations for primary and secondary prevention of GC in asymptomatic standard-risk populations in Chile. METHODS: Two on-line synchronous workshops and a seminar were conducted with Chilean experts. A Delphi panel consensus was conducted over 2 rounds to achieve>80% agreement on proposed primary and secondary prevention strategies for the population stratified by age groups. RESULTS: 10, 12, and 12 experts participated in two workshops and a seminar, respectively. In the Delphi panel, 25 out of 37 experts (77.14%) and 28 out of 52 experts (53.85%) responded. For the population aged 16-34, there was no consensus on non-invasive testing and treatment for H. pylori, and the use of EGD was excluded. For the 35-44 age group, non-invasive testing and treatment for H. pylori is recommended, followed by subsequent test-of-cure using non-invasive tests (stool antigen test or urea breath test). In the ≥45 age group, a combined strategy is recommended, involving H. pylori testing and treatment plus non-invasive biomarkers (H. pylori IgG serology and serum pepsinogens I and II); subsequently, a selected group of subjects will undergo EGD with gastric biopsies (Sydney Protocol), which will be used to stratify surveillance according to the classification Operative Link for Gastritis Assessment (OLGA); every 3 years for OLGA III-IV and every 5 years for OLGA I-II. CONCLUSION: A "test-and-treat" strategy for H. pylori infection based on non-invasive studies (primary prevention) is proposed in the 35-44 age group, and a combined strategy (serology and EGD) is recommended for the ≥45 age group (primary and secondary prevention). These strategies are potentially applicable to other countries in LAC.
Assuntos
Consenso , Técnica Delphi , Infecções por Helicobacter , Helicobacter pylori , Prevenção Primária , Prevenção Secundária , Neoplasias Gástricas , Neoplasias Gástricas/prevenção & controle , Humanos , Chile , Infecções por Helicobacter/complicações , Prevenção Secundária/métodos , Adulto , Adulto Jovem , Adolescente , Pessoa de Meia-Idade , Masculino , FemininoRESUMO
INTRODUCTION: Gastric cancer (GC) is one of the most lethal malignancies worldwide. Helicobacter pylori is the primary cause of GC; therefore, its eradication reduces the risk of developing this neoplasia. There is extensive evidence regarding quadruple therapy with relevance to the European population. However, in Latin America, data are scarce. Furthermore, there is limited information about the eradication rates achieved by antibiotic schemes in European and Latin American populations. OBJECTIVE: To compare the effectiveness of standard triple therapy (STT), quadruple concomitant therapy (QCT), and bismuth quadruple therapy (QBT) in six centers in Europe and Latin America. METHODS: A retrospective study was carried out based on the LEGACy registry from 2017 to 2022. Data from adult patients recruited in Portugal, Spain, Chile, Mexico, and Paraguay with confirmed H. pylori infection who received eradication therapy and confirmatory tests at least 1 month apart were included. Treatment success by each scheme was compared using a mixed multilevel Poisson regression, adjusting for patient sex and age, together with country-specific variables, including prevalence of H. pylori antibiotic resistance (clarithromycin, metronidazole, and amoxicillin), and CYP2C19 polymorphisms. RESULTS: 772 patients were incorporated (64.64% females; mean age of 52.93 years). The total H. pylori eradication rates were 75.20% (255/339) with STT, 88.70% (159/178) with QCT, and 91.30% (191/209) with QBT. Both quadruple therapies (QCT-QBT) showed significantly higher eradication rates compared with STT, with an adjusted incidence risk ratio (IRR) of 1.25 (p: <0.05); and 1.24 (p: <0.05), respectively. The antibiotic-resistance prevalence by country, but not the prevalence of CYP2C19 polymorphism, showed a statistically significant impact on eradication success. CONCLUSIONS: Both QCT and QBT are superior to STT for H. pylori eradication when adjusted for country-specific antibiotic resistance and CYP2C19 polymorphism in a sample of individuals residing in five countries within two continents.
RESUMO
Obesity is a very common pathology worldwide. Among the management alternatives are glucagon-like peptide-1 (GLP-1) analogues, a hormone secreted mainly by the intestine. Apart from its effects as an incretin, effects on gastrointestinal motility have been described, which seem to be fundamental for its effect on obesity, but also the cause of its most frequent potential adverse effects. There is discussion regarding the large number of case reports in relation to the retention of gastric contents at the time of endoscopy. There is currently insufficient evidence to state categorically that they produce a significant change in gastric emptying. Nevertheless, it is recommended to inquire about the use of these drugs before endoscopic procedures that require sedation and, in the presence of symptoms, to suggest changes in the preparation
La obesidad es una patología muy frecuente a nivel global. Dentro de las alternativas del manejo están los análogos del péptido 1 similar al glucagón (GLP-1), hormona secretada principalmente por el intestino. Aparte de sus efec- tos como incretina, se han descrito efectos sobre la motilidad gastrointestinal, los que parecen ser fundamentales para su efecto sobre la obesidad, pero también los causales de sus potenciales efectos adversos más frecuentes. Existe discusión en relación con la gran cantidad de reportes de casos en relación con la retención de contenido gástrico al momento de una endoscopia. Actualmente no existe evidencia suficiente para afirmar categóricamente que producen un cambio significativo en el vaciamiento gástrico. No obstante, se recomienda indagar sobre el uso de estos fármacos antes de procedimientos endoscópicos que requieran sedación y, ante la presencia de síntomas, sugerir cambios en la preparación.