Management of Helicobacter pylori Infection: Myanmar Consensus Report

Myanmar has a significant rate of Helicobacter pylori (H. pylori) infection among Southeast Asian countries. The complications of H. pylori infections are common in Myanmar, ranging from peptic ulcer bleeding to gastric cancer. Myanmar has an intermediate risk of gastric cancer. In view of increasing drug resistance particularly to triple therapy, a standard management guideline is needed in Myanmar for the effective management of H. pylori infection. This is the first consensus guideline in Myanmar for local clinical practice. The consensus group consisted of 39 gastroenterologists and clinicians from Myanmar GI & Liver Society (MGLS), who had discussions in integrated meetings and developed consensus statements with the Delphi method and focused on the grades of recommendations, levels of evidence, and rationales for the management of H. pylori infection in daily practice in Myanmar. Due to the limited availability of high-quality local evidence, these consensus recommendations were based upon the best available evidence from the world's literature and guidelines, with special attention given to evidence from Myanmar. This consensus followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). The consensus level was defined as ≥ 80% for agreement on each statement. Finally, the panel reached a consensus on 26 statements which focus on four areas: (1) whom to test, (2) how to test, (3) whom to treat, and (4) how to treat with post-treatment confirmation of H. pylori status. This consensus will guide the proper diagnosis and treatment of H. pylori infection. In order to prevent antibiotic resistance, H. pylori infected individuals must have successful eradication. Future studies require third-line regimens and the development of antibiotic sensitivity tests. This consensus will serve as a useful guide for clinicians in their day-to-day clinical work.