Recommendations for diagnosis of H pylori formulated in the Maastricht III Consensus Report, with levels of scientific evidence and grades of recommendation
| Recommendations | Level of evidence | Grade of recommendation | |
|---|---|---|---|
| The non-invasive tests that can be used for the test and treat strategy are UBT and the stool antigen tests. Certain kits for serology with high accuracy can also be applied | 1a | B | |
| PPI is a source of false negative diagnostic tests except serology. PPIs should be stopped for at least 2 weeks before performing a diagnostic test | 1b | A | |
| Serology should be considered as a diagnostic test when other diagnostic tests might be false negative, such as in patients with bleeding ulcers, gastric atrophy, MALT lymphoma, and recent or current use of PPIs and antibiotics | 2 | B | |
| The serological tests are not all equivalent and different tests may be applied in different situations | 2b | B | |
| The detection of specific H pylori antibodies in urine and saliva has no current role in patient management but can he helpful for epidemiological studies | 1b | A | |
| Serology based near doctor-patient tests have no current role in the management of H pylori infection | 1 | A | |
| Detection of H pylori pathogenic factors and the study of host genetic polymorphisms is not helpful in the management of H pylori infection | 3b | D | |
| It is recommended that a follow-up evaluation to confirm successful eradication be performed after H pylori eradication with UBT if available. If not available a laboratory based stool test, preferably using monoclonal antibodies, could be used | 1b | A | |
| Culture and antimicrobial sensitivity testing should be routinely performed: | |||
| Before clarithromycin based treatment, if primary resistance to clarithromycin is greater than 15–20% in the respective area | |||
| After two treatment failures with different antibiotics | 1b | B | |
| Monitoring of primary antibiotic resistance should be carried out in reference laboratories in different areas: | |||
| In patients presenting for endoscopy without pretreatment, a positive rapid urease test is sufficient to initiate treatment | 2 | A |