Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Issue 6 (14th December 2006)

• Record Type: Journal Article
• Authors: Malfertheiner, P; Megraud, F; O'Morain, C; Bazzoli, F; El-Omar, E; Graham, D; Hunt, R; Rokkas, T; Vakil, N; Kuipers, E J
• Other Names: group-author.
• Is Part Of: Gut. Volume 56:Issue 6(2007)
• Page Start: 772
• Page End: 781
• Publication Date: 2006-12-14
• Subjects: BabA2, blood group antigen binding adhesin 2 -- CagA, cytotoxin associated gene A -- EHSG, European Helicobacter Study Group -- GORD, gastro-oesophageal reflux disease -- IDA, iron deficiency anaemia -- ITP, idiopathic thrombocytopenic purpura -- MALT, mucosa associated lymphoid tissue -- NSAIDs, non-steroidal anti-inflammatory drugs -- OipA, outer inflammatory protein A -- PPIs, proton pump inhibitors -- RCT, randomised controlled trial -- SabA, sialic acid binding adhesion -- UBT, 13C-urea breath test -- VacA, vacuolating associated gene A; H pylori -- diseases -- diagnosis -- treatment -- prevention; Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gut.2006.101634
• Languages: English
• ISSNs: 0017-5749

Abstract

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 "test and treat" 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 anti-inflammatory 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 non-invasive 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.