Current concepts in the management of Helicobacter pylori infection - The Maastricht III Consensus Report

¹ University of Magdeburg, Germany
² Laboratoire de Bacteriologie - C.H.U. Pellegrin, France
³ Adelaide and Meath Hospital, Trinity College, Eire
⁴ University di Bologna, Italy
⁵ Aberdeen University, United Kingdom
⁶ Michael E. DeBakey VAMC, and Baylor College of Medicine, United States
⁷ McMaster University, Canada
⁸ 'Henry Dunant Hospital', Athens, Greece
⁹ University of Wisconsin Medical School, United States
¹⁰ Erasmus MC University Medical Center, Netherlands

^* To whom correspondence should be addressed. E-mail: peter.malfertheiner{at}medizin.uni-magdeburg.de.

Accepted 21 November 2006

	Abstract

The European Helicobacter Study Group (EHSG) convened the third Maastricht Consensus conference, to update guidelines on the management of Helicobacter pylori. The guidelines cover indications for therapy, management and treatment strategies. The potential of H. pylori eradication for the prevention of gastric cancer was underlined. The eradication of H. pylori infection is recommended in patients with (i ) gastro-duodenal pathologies such as peptic ulcer disease and low-grade gastric mucosa-associated lymphoid tissue lymphoma (MALT lymphoma), (ii) atrophic gastritis, (iii) first-degree relatives of gastric cancer patients, (iv) unexplained iron deficiency anaemia (v) chronic idiopathic thrombocytopenic purpura. Recurrent abdominal pain in children is an indication for a test and treat strategy if other causes are excluded. The eradication of H. pylori infection (i) does not cause gastro-oesophageal reflux disease (GORD) or exacerbate GORD, and (II) may prevent peptic ulcer in patients who are naïve non steroidal anti inflammatory drugs (NSAIDs) users. H. pylori eradication is less effective then proton pump inhibitor 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 age cut-off may vary locally). The non-invasive tests that should be used for the diagnosis of H. pylori infection are the urea breath test, stool antigen tests and serological kits with a high accuracy. Triple therapy using a PPI with amoxicillin and clarithromycin or metronidazole given twice daily remains the recommended first choice therapy. Bismuth containing quadruple therapy, if available, is also a first choice treatment option. Rescue therapy should be based on antimicrobial susceptibility. 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.

Keywords: Helicobacter pylori infection, diagnosis, indications, prevention, therapy

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