Statements concerning the relation between H pylori and gastric cancer formulated in the Maastricht III Consensus Report, with levels of scientific evidence and grades of recommendation
| Statements | Level of evidence | Grade of recommendation | |
|---|---|---|---|
| *1 grade of recommendation differs for some statements from the criteria presented in table 1, because the expert group interpreted the study results in a different way, or more studies on the same topic had conflicting results; *2 cost analysis studies currently available are based on different economic models and scenarios. | |||
| The global burden of gastric cancer increasing, predominantly in developing countries | *1 | A | |
| H pylori infection is the most common proven risk factor for human non-cardiac gastric cancer | A | ||
| The risk for gastric cancer development depends on bacterial virulence factors | A | ||
| The risk for gastric cancer development depends on host genetic factors | B | ||
| Environmental factors contribute to the risk of gastric cancer | A | ||
| Evidence for H pylori as an important factor for gastric cancer development is shown by experimental animal models | B | ||
| Eradication of H pylori prevents development of pre-neoplastic changes of the gastric mucosa | 1b | A | |
| Eradication of H pylori has the potential to reduce the risk of gastric cancer development | 1c | B | |
| The optimal time to eradicate H pylori is before pre-neoplastic conditions (atrophy, intestinal metaplasia) are present, probably in early adulthood | 1b | A | |
| H pylori eradication for gastric cancer prevention is cost effective in economic analyses. Feasibility studies are required to evaluate further the benefits and risks of this strategy | *2 | B | |
| The potential for gastric cancer prevention on a global scale is restricted by currently available treatments | 1b | A | |
| New treatments are required for a global strategy of eradication to prevent gastric cancer | A | ||
| H pylori eradication for gastric cancer prevention in populations at risk should he evaluated and considered | 2a | B | |