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1、第一部分什么样的病人需要接受除菌治疗？意见1. A test-and-treat strategy is appropriate for uninvestigateddyspepsia in popul ations where the H pylori prevalence is high ($ 20%). Thisapproach is subject to loc al cost e benefit considerations and is notapplicable to patient s with alarm symptoms , or older patients (age t
2、o bedetermined locally according to cancer risk)证据级别：1a幽门螺杆菌高感染率地区（感染率20%）的消化不良患者，可选用“检查-治疗“方案，即选择非侵入性检查检测幽门螺杆菌，并对阳性患者进行杀菌治疗。是否选择“检查-治疗”方案取决于当地的费效比，具报警症状及高龄（高龄的界定取决于当地肿瘤风险）患者不适用“检查-治疗”方案。意见2. Statement 2: The main non-invasive tests that can be used for thetest-and-treat strategy are the UBT and mon
3、oclonal stool antigen tests. Certainvalidated serological tests can also be used.证据级别：2a主流的非侵入性幽门螺杆菌检查方法包括UBT检测、大便抗原单克隆抗体检测及部分被证明可信度高的血清学检查。意见3. H pylori eradication produces long-term relief of dyspepsia inone of 12 patients with H pylori and functional dyspepsia; this is better thanany other treat
4、ment.证据级别：1a根除幽门螺杆菌可使1/12的幽门螺杆菌阳性的功能性消化不良患者症状得到长期缓解，效果优于其他任何治疗方法。意见4. H pylori can increase or decrease acid secretion depending on theintragastric distributio n of inflammation.证据级别：2b幽门螺杆菌抑制或增加胃酸分泌取决于胃内炎症的分布。意见5. On average, H pylori status has no effect on symptom severity,symptom recurrence and
5、treatment efficacy in GORD. H pylori eradication doesnot exacerbate pre-existing GORD or affect treatment efficacy.证据级别：1a整体来说，幽门螺杆菌与胃食管反流疾病的症状严重程度、复发及疗效无显著关联。根除幽门螺杆菌不会加重既有胃食管反流疾病症状，也不会影响其疗效。意见6. Epidemiological studies show a negative association between the prevalenceof H pylori and the severity o
6、f GORD and incidence of esophageal adenocarcinoma.证据级别：2a流行病学证据表明幽门螺杆菌感染率与胃食管反流病严重程度及食管腺癌的发病率呈负相关。意见7. H pylori infection is associated with an increased risk ofuncomplicated and complicated gastroduodenal ulcers in NSAID and low-doseaspirin (acetosalicylic acid (ASA) users. Eradication reduces the
7、risk ofcomplicated and uncomplicated gastroduodenal ulcers associated with eitherNSAID or low-dose ASA use.证据级别：2a、1b使用非甾体类抗炎药及低剂量阿司匹林的患者发生伴或不伴并发症的胃十二指肠溃疡与幽门螺杆菌感染相关。上述患者根除幽门螺杆菌有助减少胃十二指肠溃疡病发生。意见8. H pylori eradication is beneficial before starting NSAIDtreatment. It is mandatory in patients with a pe
8、ptic ulcer history. However, Hpylori eradication alone does not reduce the incidence of gastroduodenal ulcersin patients already receiving long-term NSAID treatment. They require continuedPPI treatment as well as eradication treatment.证据级别：1b、1b只有在开始非甾体类抗炎药之前根除幽门螺杆菌才能使上述患者获益。既往有消化性溃疡史的病人必需在开始非甾体类抗炎药
9、之前根除幽门螺杆菌。对于已经开始长期非甾体类抗炎药治疗的患者，仅根除幽门螺杆菌不能降低其胃十二指肠溃疡发病率，该群患者需在除菌的基础上长期服用质子泵抑制剂。意见9. Testing for H pylori should be performed in ASA users with ahistory of gastroduodenal ulcer. The long-term incidence of peptic ulcerbleeding is low in these patients after receiving eradication even in the absenceof g
10、astroprotective treatment.证据级别：2b对于长期使用低剂量阿司匹林并胃十二指肠溃疡病史的患者推荐幽门螺杆菌检查。除菌治疗之后，即使不使用胃黏膜保护剂，患者也可长期维持较低的消化性溃疡出血发生率。意见10. Long-term treatment with PPIs in H pylori-positive patients is associatedwith the development of a corpus-predominant gastritis. This accelerates theprocess of loss of specialised glan
11、ds, leading to atrophic gastritis.Eradication of H pylori in patients receiving long-term PPIs heals gastritisand prevents the progres ion to atrophic gastritis . However, there is no evidencethat this reduces the risk of gastric cancer.证据级别：1c、1b幽门螺杆菌阳性患者长期接受PPI治疗与胃体为主胃炎的发生相关，可加剧特定腺体丢失，导致萎缩性胃炎。长期接受
12、PPI治疗的患者在除菌之后有助于胃炎痊愈并防止疾病向萎缩性胃炎进展，目前尚无证据表明可降低胃癌发生率。意见11. There is accumulating evidence that after H pylori eradication,corpus function may improve. However, whether this is associated withregression of atrophic gastritis remains equivocal. There is no evidence that Hpylori eradication can lead to r
13、egression of intestinal metaplasia.证据级别：2a、2a不断有证据表明除菌治疗或可使胃体功能恢复，但能否缓解胃体萎缩尚不明确。尚无证据表明除菌治疗可逆转肠上皮化生。意见12. H pylori eradication is the first-line treatment for low-gradegastric marginal zone (MALT) lymphoma证据级别：1a根除幽门杆菌为低级别MALT淋巴瘤的一线治疗。意见13. There is evidence linking H pylori to the aetiology of other
14、wiseunexplained iron-deficiency anaemia, idiopathic thrombocytopenic purpura (ITP)and vitamin B12 deficiency. In these disorder s, H pylori should be sought anderadicated. The evidence available shows no unequivocal causative associationbetween H pylori and other extragastric disorders, including ca
15、rdiovasc ularand neurological disorders.证据级别：1a、1b、3b有证据表明幽门螺杆菌与病因不明的缺铁性贫血、原发性血小板减少性紫癜及维生素B12缺乏症相关。上述患者应检测幽门螺杆菌及采取相应治疗。现有证据不能证明幽门螺杆菌与其他系统疾病相关，如心血管疾病或神经系统疾病。意见14. The evidence available shows no definite causative protectiveeffect of H pylori against the following disorders nor that its eradicationca
16、uses or worsens them. However, further resea rch is needed.1. Asthma and atopy2. Obesity and related illnesses现有证据不能表明幽门螺杆菌是下列疾病的病因或保护因素，除菌治疗对下列疾病利弊亦不明确。1.哮喘及特异质反应2.肥胖及相关疾病意见15. In H pylori-positive patients eradication treatment improves thebioavailability of thyroxine and l-dopa.证据级别：2b除菌治疗有助提高甲状腺素及左旋多巴
