Abstract
The project ‘Adapting European guidelines on Helicobacter pylori management and faecal microbiota transplantation to use in Armenia as a model for low-resource countries’ was conducted from 2017 to 2019 with funding from a UEG Activity Grant (ueg.eu/activity-grants).
As with many past socialist countries, Armenia is facing the challenges of transition from Soviet medical system to new reality where one of the important issues is the lack of national standards and guidelines, as well as the conflict between old and new school approaches in medical science and practice. The aim of this project, implemented jointly by the European Helicobacter and Microbiota Study Group, the Armenian Association of Gastroenterology and three national UEG member societies (Armenian, Italian and French), was to fill this gap by creating locally adapted guidelines on H. pylori management and faecal microbiota transplantation (FMT).
At the first meeting of the working group, a major problem was identified as being lack of information on H. pylori epidemiology in Armenia. To obtain such data, we designed and implemented a small pilot study on prevalence of H. pylori antibodies in the adult population and frequency of macrolide and fluoroquinolone resistance of the bacterium. The results were submitted and accepted for publication in the journal Gut Pathogens.
Based on these data and other relevant information on the health system, including availability of diagnostic tests and medications, the working group developed adapted guidelines on H. pylori management and FMT based on the Maastricht V/Florence consensus report and the European consensus conference on faecal microbiota transplantation in clinical practice. These were presented at a two-day conference held in Yerevan, Armenia, with participation of 185 gastroenterologists, family doctors, general practitioners, endoscopists, paediatricians and pathologists, as well as residents and medical students. Faculty included international experts in the field (Francis Megraud, Marcis Leja, Theodore Rokkas, Gianluca Ianiro, Loris Lopetuso, Dmitry Bordin) and local faculty (Manik Gemilyan, Gagik Hakobyan, Ani Kocharyan and others). The conference was highly acclaimed by attendants and rated as a great success by the international faculty. The proceedings are due for publication in the near future.
The project is a great example of international collaboration between Eastern and Western European societies for the benefit of harmonizing gastroenterology science and practice across Europe. It can serve as a model for other low resource countries and contribute not only to development of local guidelines but also to increasing professional capacities of national societies and making their efforts more effective and visible in their countries. The Armenian Association of Gastroenterology is planning the next steps, including dissemination of adapted guidelines and assessment of implementation practices among primary care physicians and gastroenterologists, as well as new collaborative projects with UEG member societies.