Recommendations for H. pylori management strategies included that a "test and treat" approach be used in adult patients with persistent dyspepsia under the age of 45 years, having excluded those with predominantly GERD symptoms, NSAID users, and patients with alarm symptoms or family history of gastric cancer.
It was also recommended that infection diagnosis should be by UBT or stool antigen test. Successful eradication should always be tested for by UBT, or endoscopy-based test - if endoscopy is clinically indicated.
They continued by suggesting that: in uncomplicated DU patients, eradication therapy does not need to be followed by further antisectory treatment; patients who fail second line quadruple therapy in primary care should be referred; and H. pylori eradication is not generally indicated for extra-alimentary disease.
In relation to public health issues, they recommended that: a "search and treat" strategy for PUD patients on long-term and intermittent antisecretory therapy be followed; and that resistance surveillance programmes should be implemented since clarithromycin resistance affects efficacy of first line therapy.
They went on to say that H. pylori is an established etological factor for non-cardia gastric cancer. Although a substantial proportion of gastric cancer can be attributed to H. pylori infection, only a minority of infected subjects will develop gastric cancer. Therefore the asymptomatic general population should not be screened for H. pylori at present.
Finally, in relation to pediatric patients, Maastricht 2-2000 accepted the position paper of the EHPSG and ESPGHAN (J Pediatr Gastroenterol Nutr 2000; 30: 208-13.)