Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report
- P Malfertheiner1,
- F Megraud2,
- C O’Morain3,
- F Bazzoli4,
- E El-Omar5,
- D Graham6,
- R Hunt7,
- T Rokkas8,
- N Vakil9,
- E J Kuipers10,
- The European Helicobacter Study Group (EHSG)
- 1Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
- 2INSERM U853, Bordeaux, France
- 3Adelaide and Meath Hospital, Trinity College, Dublin, Ireland
- 4University of Bologna, Bologna, Italy
- 5Aberdeen University, Aberdeen, UK
- 6VA Medical Center Houston, Texas, USA
- 7McMaster University, Hamilton, Ontario, Canada
- 8Henry-Dunant Hospital, Athens, Greece
- 9University of Wisconsin Medical School, Milwaukee, USA
- 10Erasmus MC University Medical Center, Rotterdam, Netherlands
- Correspondence to:
Professor P Malfertheiner
Otto-von-Guericke-Universität Magdeburg, Medizinische Fakultät, Zentrum für Innere Medizin, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Leipziger Straße 44, D-39120 Magdeburg, Germany;
- Accepted 21 November 2006
- Published Online First 14 December 2006
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 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.
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.
- BabA2, blood group antigen binding adhesin 2
- CagA, cytotoxin associated gene A
- EHSG, European Helicobacter Study Group
- GORD, gastro-oesophageal reflux disease
- IDA, iron deficiency anaemia
- ITP, idiopathic thrombocytopenic purpura
- MALT, mucosa associated lymphoid tissue
- NSAIDs, non-steroidal anti-inflammatory drugs
- OipA, outer inflammatory protein A
- PPIs, proton pump inhibitors
- RCT, randomised controlled trial
- SabA, sialic acid binding adhesion
- UBT, 13C-urea breath test
- VacA, vacuolating associated gene A
Published Online First 14 December 2006
Competing interests: None
Extracts in abstract form and comments have been published in Italian. Short extracts have been published in GI Forefront, based on a presentation to the Japanese Society of Gastroenterology and a European short version release.
Since the Maastricht conference new additional publications in support of the recommendations and statements, are included to update the manuscript.