The European Helicobacter Pylori Study Group (EHPSG) organized a meeting of specialists and experts from around the world, representatives from National Gastroenterology Societies, and GPs from Europe, which took place between 21 and 22 September 2000.
Recommendations for the management of H. pylori included a "test and treat" approach in adults under 45 years, with persistent dyspepsia. Patients with predominantly gastroesophageal reflux disease (GERD) symptoms, nonsteroidal anti-inflammatory drug (NSAID) users, and those with alarm symptoms should first be excluded.
Diagnosis of infection should be by urea breath test or stool antigen test. Urea breath test or an endoscopy-based test should always be used to confirm successful eradication - if endoscopy is clinically indicated.
The EHPSG strongly recommended eradication of H. pylori in all patients with peptic ulcer.
Eradication should also be conducted in patients who are first-degree relatives of gastric cancer patients, and should be considered in infected patients with functional dyspepsia.
| Guidelines on the management of H. pylori infection have been updated.
| Alimentary Pharmacology & Therapeutics |
There was consensus that the eradication of H. pylori is not associated with the development of GERD in most cases, and does not exacerbate existing GERD.
It was agreed that the eradication of H. pylori prior to the use of NSAIDs reduces the incidence of peptic ulcer, but does not enhance the healing of gastric or duodenal ulcer in patients receiving antisecretory therapy who continue to take NSAIDs.
In patients with uncomplicated duodenal ulcer, eradication therapy does not need to be followed by further antisecretory treatment.
They added that treatment should be thought of as a package that considers first- and second-line eradication therapies together.
First-line therapy should be with triple therapy, using a proton pump inhibitor or ranitidine bismuth citrate, combined with clarithromycin and amoxicillin or metronidazole.
Second-line therapy should use quadruple therapy with a proton pump inhibitor, bismuth, metronidazole and tetracycline.
Where bismuth is not available, second-line therapy should be with proton pump inhibitor-based triple therapy.
If second-line quadruple therapy fails in primary care, they recommended that patients should be referred to a specialist.