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

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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., Hunt, R., Rokkas, T., Vakil, N., Kuipers, E. J., & 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