Background: Guidelines on the management of Helicobacter pylori, which cover indications for management and treatment strategies, were produced in 2000. Aims: To update the guidelines at the European Helicobacter Study Group (EHSG) Third Maastricht Consensus Conference, with emphasis on the potential of H pylori eradication for the prevention of gastric cancer. Results: Eradication of H pylori infection is recommended in (a) patients with gastroduodenal diseases such as peptic ulcer disease and low grade gastric, mucosa associated lymphoid tissue (MALT) lymphoma; (b) patients with atrophic gastritis; (c) first degree relatives of patients with gastric cancer; (d) patients with unexplained iron deficiency anaemia; and (e) patients with chronic idiopathic thrombocytopenic purpura. Recurrent abdominal pain in children is not an indication for a âtest and treatâ strategy if other causes are excluded. Eradication of H pylori infection (a) does not cause gastro-oesophageal reflux disease (GORD) or exacerbate GORD, and (b) may prevent peptic ulcer in patients who are naïve users of non-steroidal antiinflammatory drugs (NSAIDs). H pylori eradication is less effective than proton pump inhibitor (PPI) treatment in preventing ulcer recurrence in long term NSAID users. In primary care a test and treat strategy using a noninvasive test is recommended in adult patients with persistent dyspepsia under the age of 45. The urea breath test, stool antigen tests, and serological kits with a high accuracy are non-invasive tests which should be used for the diagnosis of H pylori infection. Triple therapy using a PPI with clarithromycin and amoxicillin or metronidazole given twice daily remains the recommended first choice treatment. Bismuth-containing quadruple therapy, if available, is also a first choice treatment option. Rescue treatment should be based on antimicrobial susceptibility. Conclusion: The global burden of gastric cancer is considerable but varies geographically. Eradication of H pylori infection has the potential to reduce the risk of gastric cancer development.
Current concepts in the management of helicobacter pylori infection: The maastricht III consensus report / Malfertheiner, P.; Megraud, F.; O’Morain, C.; Bazzoli, F.; El-Omar, E.; Graham, D.; Hunt, R.; Rokkas, T.; Vakil, N.; Kuipers, E. J.; Andersen, Leif; Atherton, John; Asaka, Masahiro; Bazzoli, Franco; Bytzer, Peter; Chan, Francio; Coelho, Luiz Gonzaga Vaz; De Wit, Niek; Delchier, Jean Charles; Di Mario, Francesco; El-Omar, Emad; Fock, Kwong Ming; Forman, David; Fujioka, Toshio; Gasbarrini, Giovanni; Genta, Robert; Goh, K. L.; Graham, David Y.; Hirschl, Alexander; Hungin, Pali; Hunt, Richard; Isakov, Vassili A.; Jones, Roger; Kist, Manfred; Koletzko, Sibylle; Kuipers, Ernst J.; Kupcinskas, Limas; Ladas, Spiros; Lanas, Angel; Machado, Jose; Malfertheiner, Peter; Mccoll, Kenneth E. L.; Mégraud, Francio; Michetti, Pierre; Moayyedi, Paul; Omorain, Colm; Pilotto, Alberto; Quina, Mario; Rokkas, Theodore; Sharma, Patreek; Simsek, Ylkay; Sipponen, Pentii; Sollano, J.; Stockbrügger, Reinold; Sugano, Kentaro; Vaira, Dino; Vakil, Nimish; Vieth, Michael; Xiao, Shudong. - In: GUT. - ISSN 0017-5749. - 56:6(2007), pp. 772-781. [10.1136/gut.2006.101634]
Current concepts in the management of helicobacter pylori infection: The maastricht III consensus report
Di Mario, Francesco;Pilotto, Alberto;
2007-01-01
Abstract
Background: Guidelines on the management of Helicobacter pylori, which cover indications for management and treatment strategies, were produced in 2000. Aims: To update the guidelines at the European Helicobacter Study Group (EHSG) Third Maastricht Consensus Conference, with emphasis on the potential of H pylori eradication for the prevention of gastric cancer. Results: Eradication of H pylori infection is recommended in (a) patients with gastroduodenal diseases such as peptic ulcer disease and low grade gastric, mucosa associated lymphoid tissue (MALT) lymphoma; (b) patients with atrophic gastritis; (c) first degree relatives of patients with gastric cancer; (d) patients with unexplained iron deficiency anaemia; and (e) patients with chronic idiopathic thrombocytopenic purpura. Recurrent abdominal pain in children is not an indication for a âtest and treatâ strategy if other causes are excluded. Eradication of H pylori infection (a) does not cause gastro-oesophageal reflux disease (GORD) or exacerbate GORD, and (b) may prevent peptic ulcer in patients who are naïve users of non-steroidal antiinflammatory drugs (NSAIDs). H pylori eradication is less effective than proton pump inhibitor (PPI) treatment in preventing ulcer recurrence in long term NSAID users. In primary care a test and treat strategy using a noninvasive test is recommended in adult patients with persistent dyspepsia under the age of 45. The urea breath test, stool antigen tests, and serological kits with a high accuracy are non-invasive tests which should be used for the diagnosis of H pylori infection. Triple therapy using a PPI with clarithromycin and amoxicillin or metronidazole given twice daily remains the recommended first choice treatment. Bismuth-containing quadruple therapy, if available, is also a first choice treatment option. Rescue treatment should be based on antimicrobial susceptibility. Conclusion: The global burden of gastric cancer is considerable but varies geographically. Eradication of H pylori infection has the potential to reduce the risk of gastric cancer development.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
