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Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report
  1. P Malfertheiner1,
  2. F Megraud2,
  3. C O’Morain3,
  4. F Bazzoli4,
  5. E El-Omar5,
  6. D Graham6,
  7. R Hunt7,
  8. T Rokkas8,
  9. N Vakil9,
  10. E J Kuipers10,
  11. The European Helicobacter Study Group (EHSG)
  1. 1Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
  2. 2INSERM U853, Bordeaux, France
  3. 3Adelaide and Meath Hospital, Trinity College, Dublin, Ireland
  4. 4University of Bologna, Bologna, Italy
  5. 5Aberdeen University, Aberdeen, UK
  6. 6VA Medical Center Houston, Texas, USA
  7. 7McMaster University, Hamilton, Ontario, Canada
  8. 8Henry-Dunant Hospital, Athens, Greece
  9. 9University of Wisconsin Medical School, Milwaukee, USA
  10. 10Erasmus MC University Medical Center, Rotterdam, Netherlands
  1. 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; peter.malfertheiner{at}


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
  • H pylori
  • diseases
  • diagnosis
  • treatment
  • prevention

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  • 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.

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