Optimized diagnosis ofHelicobacter pyloriand tailored eradication therapy for preventing gastric cancer: a proposal for SHAKE strategy

초록

Introduction To decrease gastric cancer-related mortality, the Korean National Cancer Screening Program provides biennial screening gastroscopy to all individuals aged >40 years. However, a test-and-treat strategy ofHelicobacter pylorifor preventing gastric cancer has not been established. Areas covered In this review, we present up-to-date results of endoscopic findings ofH. pylorigastritis, optimal sites forH. pyloridetection, gastric cancer risk assessment using serum pepsinogen, tailored eradication based on the antimicrobial resistance againstH. pylori, and post-eradication surveillance. Expert opinion Here we propose approaches toH. pyloridiagnosis and treatment for preventing gastric cancer, termed 'Screening forH. pyloriin Korea and Eradication (SHAKE)' strategy. This strategy consists of the following: (1) optimizedH. pyloridiagnosis, (2) individualized management based on theH. pyloriinfection status, and (3) tailored eradication therapy.H. pylorigastritis can be diagnosed by endoscopic observation of the gastric mucosal pattern at the greater curvature of the corpus. Measurement of the serum pepsinogen I/II ratio is useful for assessing the risk of gastric cancer. As a first-line treatment, tailored eradication based on the results of molecular testing is effective in a country with a high rate of clarithromycin-resistantH. pylori.

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