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背景与目的:胃癌是亚太地区的主要健康负担之一,但对其预防策略尚缺乏共识。本共识会议旨在评价预防胃癌的策略。方法:多学科专家组应用德尔菲(Delphi)法制订共识条文,提呈相关数据,对证据等级、推荐强度以及共识水平予以分级。结果:幽门螺杆菌(H.pylori)感染是非贲门胃腺癌必要但非充分的致病因子。盐的高摄入与胃癌强烈相关。新鲜果蔬对胃癌具有预防作用,但维生素和其他饮食补充并不能预防胃癌。H.pylori感染中的宿主-细菌相互作用导致不同类型的胃炎和胃酸分泌,从而决定疾病结局。胃癌阳性家族史是一个重要的危险因素。低血清胃蛋白酶原反映胃萎缩程度,可作为检出胃癌高危人群的标志物。H.pylori筛查和治疗被推荐作为减少高危人群胃癌危险性的一种策略,该策略在萎缩性胃炎发生前实施最为有效,但并不排除对胃癌高危人群的内镜监测。对胃癌低危人群不推荐行H.pylori筛查。H.pylori感染的一线治疗应遵循国家治疗指南。结论:高危人群中H.pylori筛查和根除策略可能会减少胃癌的发生率,本共识根据现有证据予以推荐。
Background and Objective: Gastric cancer is one of the major health burdens in the Asia Pacific region, but there is still a lack of consensus on its prevention strategy. This consensus meeting aims to evaluate strategies for preventing gastric cancer. Methods: A multidisciplinary group of experts applied the Delphi method to make consensus provisions, presented relevant data, and rated the level of evidence, recommended intensity, and consensus level. Results: H. pylori infection is a necessary but not sufficient causative agent of non-cardiac gastric adenocarcinoma. High salt intake is strongly associated with gastric cancer. Fresh fruits and vegetables have a preventive effect on gastric cancer, but vitamins and other dietary supplements do not prevent gastric cancer. Host-bacterial interactions in H. pylori infection lead to different types of gastritis and gastric acid secretion, which determine the disease outcome. Positive family history of gastric cancer is an important risk factor. Low serum pepsinogen reflects the degree of gastric atrophy, can be used as a marker of high-risk gastric cancer patients. Screening and treatment of H.pylori is recommended as a strategy to reduce the risk of gastric cancer in high-risk populations. This strategy is most effective prior to the onset of atrophic gastritis but does not exclude the endoscopic surveillance of people at high risk for gastric cancer. H.pylori screening is not recommended for low-risk gastric cancer. First-line treatment of H. pylori infection should follow the guidelines of national treatment. CONCLUSION: Screening and eradication strategies for H.pylori in high-risk populations may reduce the incidence of gastric cancer. This consensus is based on available evidence.