Setting a Standard for Helicobacter pylori Management in Pakistan

H. pylori infection is prevalent in Pakistan, affecting nearly 81% of the population. Many high-quality clinical practice guidelines (CPGs) have been developed in high-income countries. Low- and middle-income countries (LMICs) face challenges in developing de novo CPGs. Modifying pre-existing guidelines through the GRADE-ADOLOPMENT process is a practical approach to addressing this issue. We aimed to create a contextually relevant and comprehensive CPG for H. pylori management in Pakistan.

The selected source guidelines underwent a thorough literature review and evaluation aligned with the GRADE approach. Recommendations were categorized as "Adopt," "Adapt," or "Exclude" after assessment by expert gastroenterologists. Adopted recommendations were included as-is or with minor changes. Excluded recommendations were removed, while adapted recommendations underwent significant alterations through the GRADE-ADOLOPMENT process. The GRADEPro application and Evidence to Decision tables aided the consensus process. The final meeting resulted in unanimous agreement on the CPG.

The source guidelines included 33 recommendations: 29 were adopted, and three were excluded. One recommendation required adaptation: "non-endoscopic testing for H. pylori infection is an option for patients under 60 with uninvestigated dyspepsia and no alarm features." According to the adapted version, patients under the age of 50 years with uninvestigated dyspepsia should undergo non-endoscopic testing.

The creation of this CPG will equip general physicians with effective management strategies. Our study presents a CPG for H. pylori infection treatment in Pakistan, recommending endoscopic testing for patients aged over 50 years. Further research is needed to investigate the efficacy of early screening for uninvestigated dyspepsia in Pakistan. Our approach can help improve patient care globally, especially in LMICs.