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 23 May 2018

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News

Maastricht III guidelines on the management of H pylori

June's issue of Gut studies the current concepts in the management of Helicobacter pylori infection

News image

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Guidelines on the management of Helicobacter pylori, which cover indications for management and treatment strategies, were produced in 2000.

Professor P. Malfertheiner and colleagues from Europe and the USA updated 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.

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.

Eradication of H pylori infection does not cause GORD
Gut

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.

Professor Malfertheiner concluded that, "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".

Gut 2007; 56 (6), 772-781
13 June 2007

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