Setting a standard for helicobacter pylori management in Pakistan

Authors

• Syeda Amrah Hashmi, Aga Khan UniversityFollow
• Amna Rashid Hanfee, Aga Khan UniversityFollow
• Sajjan Raja, Aga Khan UniversityFollow
• Zahabia Sohail, Aga Khan UniversityFollow
• Shahab Abid, Aga Khan UniversityFollow
• Adeel Ur rehman, Aga Khan UniversityFollow
• Alina Abdul Rehman, Aga Khan University
• Amna Subhan Butt, Aga Khan UniversityFollow
• Faisal Waseem Ismail, Aga Khan UniversityFollow
• Ali Hyder, Aga Khan UniversityFollow
• Mohsin Ali Mustafa, Aga Khan UniversityFollow
• Nashia Ali Rizvi, Aga Khan UniversityFollow
• Rustam Khan, Aga Khan UniversityFollow
• Alina Pervez, Aga Khan UniversityFollow
• Samar Fatima, Aga Khan University
• Adil H. Haider, Aga Khan University
• Om Parkash, Aga Khan UniversityFollow

Document Type

Article

Department

Medical College Pakistan; Medicine; Gastroenterology

Abstract

Objectives: 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.
Methods: 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.
Results: 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.
Conclusions: 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.

Publication (Name of Journal)

The Korean Journal of Helicobacter and Upper Gastrointestinal Research

DOI

10.7704/kjhugr.2026.0009

Recommended Citation

Hashmi, S. A., Hanfee, A. R., Raja, S., Sohail, Z., Abid, S., rehman, A. U., Rehman, A. A., Butt, A. S., Ismail, F. W., Hyder, A., Mustafa, M. A., Rizvi, N. A., Khan, R., Pervez, A., Fatima, S., Haider, A. H., Parkash, O. (2026). Setting a standard for helicobacter pylori management in Pakistan. The Korean Journal of Helicobacter and Upper Gastrointestinal Research, 26(2), 204-216.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_mc/656