Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report.
Journal: 2007/June - Gut
ISSN: 0017-5749
Abstract:
BACKGROUND
Guidelines on the management of Helicobacter pylori, which cover indications for management and treatment strategies, were produced in 2000.
OBJECTIVE
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.
CONCLUSIONS
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.
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Gut 56(6): 772-781

Current concepts in the management of <em>Helicobacter pylori</em> infection: the Maastricht III Consensus Report

P Malfertheiner, Otto‐von‐Guericke University of Magdeburg, Magdeburg, Germany
F Megraud, INSERM U853, Bordeaux, France
C O'Morain, Adelaide and Meath Hospital, Trinity College, Dublin, Ireland
F Bazzoli, University of Bologna, Bologna, Italy
E El‐Omar, Aberdeen University, Aberdeen, UK
D Graham, VA Medical Center Houston, Texas, USA
R Hunt, McMaster University, Hamilton, Ontario, Canada
T Rokkas, Henry‐Dunant Hospital, Athens, Greece
N Vakil, University of Wisconsin Medical School, Milwaukee, USA
E J Kuipers, Erasmus MC University Medical Center, Rotterdam, Netherlands
Correspondence to: Professor P Malfertheiner
Otto‐von‐Guericke‐Universität Magdeburg, Medizinische Fakultät, Zentrum für Innere Medizin, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Leipziger Straße 44, D‐39120 Magdeburg, Germany; peter.malfertheiner@medizin.uni‐magdeburg.de
P Malfertheiner, Otto‐von‐Guericke University of Magdeburg, Magdeburg, GermanyF Megraud, INSERM U853, Bordeaux, FranceC O'Morain, Adelaide and Meath Hospital, Trinity College, Dublin, IrelandF Bazzoli, University of Bologna, Bologna, ItalyE El‐Omar, Aberdeen University, Aberdeen, UKD Graham, VA Medical Center Houston, Texas, USAR Hunt, McMaster University, Hamilton, Ontario, CanadaT Rokkas, Henry‐Dunant Hospital, Athens, GreeceN Vakil, University of Wisconsin Medical School, Milwaukee, USAE J Kuipers, Erasmus MC University Medical Center, Rotterdam, NetherlandsCorrespondence to: Professor P Malfertheiner
Otto‐von‐Guericke‐Universität Magdeburg, Medizinische Fakultät, Zentrum für Innere Medizin, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Leipziger Straße 44, D‐39120 Magdeburg, Germany; peter.malfertheiner@medizin.uni‐magdeburg.de
Accepted 2006 Nov 21.

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.

Keywords: H pylori , diseases, diagnosis, treatment, prevention
Abstract

The European Helicobacter Study Group (EHSG), founded in 1987 to promote multidisciplinary research into the pathogenesis of Helicobacter pylori, has organised successful annual meetings and arranged task forces on paediatric issues and clinical trials. Consensus meetings have been convened on who to treat, and how and when to treat patients with H pylori infection. The most active area of research is into the link between H pylori and gastric cancer, a major public health issue. The Third Maastricht Consensus Conference was convened to update guidelines on the management of H pylori infection. Fifty experts from 26 countries, including primary care physicians, were involved in formulating the consensus held in March 2005. The experts were chosen based on their expertise and contribution to the published literature.

Acknowledgement

The meeting was made possible by generous grants offered by Altana, AstraZeneca, Janssen Cilag, Takeda, and Malesci (main sponsor for the local event).

Acknowledgement

Abbreviations

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 - C‐urea breath test

VacA - vacuolating associated gene A

Abbreviations

Appendix

CONFERENCE PARTICIPANTS

Andersen, Leif, Copenhagen, Denmark; Atherton, John, Nottingham, UK; Asaka, Masahiro, Sapporo, Japan; Bazzoli, Franco, Bologna, Italy; Bytzer, Peter, Glostrup, Denmark; Chan, Francio, Shatin, HongKong; Coelho, Luiz Gonzaga Vaz, Belo Horizonte, Brazil; de Wit, Niek, Utrecht, The Netherlands; Delchier, Jean Charles, Paris, France; Di Mario, Francesco, Padova, Italy; El‐Omar, Emad, Aberdeen, UK; Fock, Kwong Ming, Singapore; Forman, David, Leeds, UK; Fujioka, Toshio, Oita, Japan; Gasbarrini, Giovanni, Roma, Italy; Genta, Robert, Geneva, Switzerland; Goh, KL, Kuala Lumpur, Malaysia; Graham, David Y, Houston, Texas, USA; Hirschl, Alexander, Wien, Austria; Hungin, Pali, Durham, UK; Hunt, Richard, Ontario, Canada; Isakov, Vassili A, Moscow, Russia; Jones, Roger, London, UK; Kist, Manfred, Freiburg, Germany; Koletzko, Sibylle, München, Germany; Kuipers, Ernst J, Amsterdam, The Netherlands; Kupcinskas, Limas, Kaunas, Lithuania; Ladas, Spiros, Athens, Greece; Lanas, Angel, Zaragoza, Spain; Machado, Jose, Porto, Portugal; Malfertheiner, Peter, Magdeburg, Germany; McColl, Kenneth E. L., Glasgow, Scotland, UK; Mégraud, Francio, Bordeaux, France; Michetti, Pierre, Lausanne, Schwitzerland; Moayyedi, Paul, Hamilton, Canada; ÓMorain, Colm, Dublin, Ireland; Pilotto, Alberto, Vicenza, Italy; Quina, Mario, Lisboa, Portugal; Rokkas, Theodore, Athens, Greece; Sharma, Patreek, Missouri, USA; Simsek, Ylkay, Izmir, Turkey; Sipponen, Pentii, Esposo, Finland; Sollano, J., Manila, Philippines; Stockbrügger, Reinold, Maastricht, The Netherlands; Sugano, Kentaro, Yakushiji Tochigi, Japan; Vaira, Dino, Bologna, Italy; Vakil, Nimish, Milwaukee, WI, USA; Vieth, Michael, Bayreuth, Germany; Xiao, Shudong, Shanghai, China.

Appendix

Footnotes

Extracts in abstract form and comments have been published in Italian. Short extracts have been published in GI Forefront, based on a presentation to the Japanese Society of Gastroenterology and a European short version release.

Since the Maastricht conference new additional publications in support of the recommendations and statements, are included to update the manuscript.

Competing interests: None

Footnotes

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