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, EHSG Study Grp

Research output: Contribution to journalArticle

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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 naive 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 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.

Original languageEnglish
Pages (from-to)772-781
Number of pages10
JournalGut
Volume56
Issue number6
Early online date14 Dec 2006
DOIs
Publication statusPublished - Jun 2007

Keywords

  • gastroesophageal-reflux disease
  • randomized controlled-trial
  • C-13-UREA breath test
  • nonsteroidal antiinflammatory drugs
  • idiopathic thrombocytopaenic purpura
  • prevent gastric-cancer
  • iron-deficiency anemia
  • proton pump inhibitors
  • low-dose aspirin
  • B-cell lymphoma

Cite this

Malfertheiner, P., Megraud, F., O'Morain, C., Bazzoli, F., El-Omar, E., Graham, D., ... EHSG Study Grp (2007). Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut, 56(6), 772-781. https://doi.org/10.1136/gut.2006.101634

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.; EHSG Study Grp.

In: Gut, Vol. 56, No. 6, 06.2007, p. 772-781.

Research output: Contribution to journalArticle

Malfertheiner, P, Megraud, F, O'Morain, C, Bazzoli, F, El-Omar, E, Graham, D, Hunt, R, Rokkas, T, Vakil, N, Kuipers, EJ & EHSG Study Grp 2007, 'Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report', Gut, vol. 56, no. 6, pp. 772-781. https://doi.org/10.1136/gut.2006.101634
Malfertheiner P, Megraud F, O'Morain C, Bazzoli F, El-Omar E, Graham D et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut. 2007 Jun;56(6):772-781. https://doi.org/10.1136/gut.2006.101634
Malfertheiner, P. ; Megraud, F. ; O'Morain, C. ; Bazzoli, F. ; El-Omar, E. ; Graham, D. ; Hunt, R. ; Rokkas, T. ; Vakil, N. ; Kuipers, E. J. ; EHSG Study Grp. / Current concepts in the management of Helicobacter pylori infection : the Maastricht III Consensus Report. In: Gut. 2007 ; Vol. 56, No. 6. pp. 772-781.
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T1 - Current concepts in the management of Helicobacter pylori infection

T2 - the Maastricht III Consensus Report

AU - Malfertheiner, P.

AU - Megraud, F.

AU - O'Morain, C.

AU - Bazzoli, F.

AU - El-Omar, E.

AU - Graham, D.

AU - Hunt, R.

AU - Rokkas, T.

AU - Vakil, N.

AU - Kuipers, E. J.

AU - EHSG Study Grp

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N2 - 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 naive 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 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.

AB - 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 naive 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 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.

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KW - randomized controlled-trial

KW - C-13-UREA breath test

KW - nonsteroidal antiinflammatory drugs

KW - idiopathic thrombocytopaenic purpura

KW - prevent gastric-cancer

KW - iron-deficiency anemia

KW - proton pump inhibitors

KW - low-dose aspirin

KW - B-cell lymphoma

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DO - 10.1136/gut.2006.101634

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JO - Gut

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