Concenso maastrich

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Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report
P Malfertheiner, F Megraud, C O’Morain, F Bazzoli, E El-Omar, D Graham, R Hunt, T Rokkas, N Vakil, E J Kuipers and The European Helicobacter Study Group (EHSG) Gut 2007;56;772-781; originally published online 14 Dec 2006;doi:10.1136/gut.2006.101634

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772

HELICOBACTER PYLORI

Current concepts in themanagement of Helicobacter pylori infection: the Maastricht III Consensus Report
P Malfertheiner, F Megraud, C O’Morain, F Bazzoli, E El-Omar, D Graham, R Hunt, T Rokkas, N Vakil, E J Kuipers, The European Helicobacter Study Group (EHSG)
................................................................................................................................... Gut 2007;56:772–781. doi:10.1136/gut.2006.101634

See end of article for authors’ affiliations ........................ Correspondence to: Professor P Malfertheiner, Otto-von-GuerickeUniversitat Magdeburg, ¨ Medizinische Fakultat, ¨ Zentrum fur Innere Medizin, ¨ Klinik fur Gastroenterologie, ¨ Hepatologie und Infektiologie, Leipziger Straße 44, D-39120 Magdeburg, Germany; peter.malfertheiner@ medizin.uni-magdeburg.deAccepted21November2006 Published Online First 14 December 2006 ........................

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 pylorieradication 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 deficiencyanaemia; 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 naı users of non-steroidal anti¨veinflammatory 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 arenon-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:...