Gut 61:646-664 doi:10.1136/gutjnl-2012-302084
  • Guidelines

Management of Helicobacter pylori infection—the Maastricht IV/ Florence Consensus Report

Editor's Choice
  1. The European Helicobacter Study Group (EHSG)
  1. 1Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
  2. 2Department of Bacteriologie, INSERM U853, Université Bordeaux Segalen 2, Bordeaux, France
  3. 3Department of Gastroenterology, Adelaide and Meath Hospital, Trinity College, Dublin, Ireland
  4. 4School of Clinical Sciences, University of Nottingham, Nothingham, UK
  5. 5Spire Leeds Hospital, Leeds, Uk
  6. 6Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy
  7. 7Division of Applied Medicine, Aberdeen University, Aberdeen, UK
  8. 8University of Firenze, Firenze, Italy
  9. 9Hospital Universitario de La Princesa, IP and CIBEREHD Madrid, Spain
  10. 10VA Medical Center Houston, Texas, USA
  11. 11Department of Gastroenterology, Henry-Dunant Hospital, Athens, Greece
  12. 12Erasmus MC University Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Professor Peter Malfertheiner, Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University of Magdeburg, Leipziger Str 44, Magdeburg 39120, Germany; peter.malfertheiner{at}
  1. Contributors LP Andersen (Denmark), J Atherton (UK), A Axon (UK), F Bazzoli (Italy), A Burette (Belgium), X Calvet (Spain), F Chan (Hongkong), L Coelho (Brazil), JC Delchier (France), F Di Mario (Italy), E El-Omar (UK), W Fischbach (Germany), KM Fock (Singapore), G Gasbarrini (Italy), G Gensini (Italy), J Gisbert (Spain), KL Goh (Malaysia), DY Graham (USA), P Hungin (UK), R Hunt (Canada), VA Isakov (Russia), M Kist (Germany), S Koletzko (Germany), EJ Kuipers (The Netherlands), L Kupcinskas (Kaunas), S Ladas (Greece), A Lanas (Spain), M Leja (Lattvia), JC Machado (Portugal), V Mahachai (Thailand) P Malfertheiner (Germany), K McColl (England), F Megraud (France), Y Niv (Israel), C O'Morain (Ireland), A Pilotto (Italy), A Ristimaki (Finland), T Rokkas (Greece), M Rugge (Italy), R Stockbrügger (Italy), K Sugano (Japan), D Vaira (Italy), N Vakil (USA), M Vieth (Germany).

  • Accepted 22 February 2012


Management of Helicobacter pylori infection is evolving and in this 4th edition of the Maastricht consensus report aspects related to the clinical role of H pylori were looked at again in 2010. In the 4th Maastricht/Florence Consensus Conference 44 experts from 24 countries took active part and examined key clinical aspects in three subdivided workshops: (1) Indications and contraindications for diagnosis and treatment, focusing on dyspepsia, non-steroidal anti-inflammatory drugs or aspirin use, gastro-oesophageal reflux disease and extraintestinal manifestations of the infection. (2) Diagnostic tests and treatment of infection. (3) Prevention of gastric cancer and other complications. The results of the individual workshops were submitted to a final consensus voting to all participants. Recommendations are provided on the basis of the best current evidence and plausibility to guide doctors involved in the management of this infection associated with various clinical conditions.


  • Disclosures The following participants disclosed no financial relationship relevant to this publication: LP Andersen, A Axon, F Bazzoli, A Burette, L Coelho, KM Fock, G Gasbarrini, G Gensini, J Gisbert, KL Goh, R Hunt, VA Isakov, L Kupcinskas, S Koletzko, EJ Kuipers, S Ladas, M Leja, JC Machado, Y Niv, A Ristimäki, T Rokkas, R Rugge, R Stockbrügger, M Vieth. The following participants disclosed a financial relationship: J Atherton: is a consultant for Axcan Pharma, Danone and Clinova Ltd X. Calvet:has participated in advisory boards of AstraZeneca, has served as speaker for AstraZeneca and Almirall-Prodesfarma and has received research support from AstraZeneca and Janssen-Cilag. F Chan: consultant: Pfizer, speaker's honoraria: AstraZeneca, Pfizer, Takeda, Steering Committee/Adjudication: Pfizer. Commitee member for the CONDOR study. JC Delchier: is consultant for Aptalis Pharma in relation with the treatment of H pylori with Pylera. F Di Mario: none declared. E El-Omar: none declared. W Fischbach: research grant: Deutsche Krebshilfe, speaker's honoraria: Abbott, Aptalis, Falk, Merck Serono, Norgine, Novartis, Nycomed, Pfizer, Roche, Sanofi-Aventis, Shire. Consultant: Fresenius Biotech, Norgine, Pfizer, Vifor Pharma. DY Graham: is an unpaid consultant for Novartis in relation to vaccine development for treatment or prevention of H pylori infection. He is also a paid consultant for Otsuka Pharmaceuticals regarding diagnostic testing and until recently has received royalties from Baylor College of Medicine on patients covering materials related to [13C]urea breath test. P Hungin: has received research funding, travel and speakers fee from Reckitt Benckiser for upper gastrointestinal problems. M Kist: research support by Nycomed Deutschland GmbH, Honorary: Aptalis. Scientific Advisory Board: Aptalis. A Lanas: is advisor to AstraZeneca, Pfizer and Bayer. P Malfertheiner: speaker's fee: Aptalis, Falk Foundation, Abbott, AstraZeneca. Research grant: Novartis. K McColl: received consultancy fees from Reckitt Benckiser. V Mahachai: is currently obtaining grant support from Daiichi Sankyu, Japan. F Megraud: received research grants and served as consultant for Aptalis Pharma, Danone Research, and speaker for Aptalis Pharma, AstraZeneca. C O'Morain: has received research grants from Abbott and MSD and served on advisory boards of Abbott, Aptalis, Falk Pharma, MSD and Shire. A Pilotto: none declared. K Sugano: research grants from Astellas, AstraZeneca, Eisai and Takeda, fees for advisory board from Takeda and AstraZenecaand a lecture fee from Takeda. D Vaira: none declared. N Vakil: is concultant for AstraZeneca, Takeda, Otsuka, Ironwood, Orexo. Stock options: Meridian Diagnostics, Orexo.

  • Scientific secretaries P Lehours, A O'Connor, M Selgrad. We acknowledge the editorial assistance of Mrs. D. Deutschländer.

  • Funding This study was supported by an unrestricted grant: Menarini Foundation (Firenze, Italy).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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