Table 6

 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

StatementsLevel of evidenceGrade 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*1A
H pylori infection is the most common proven risk factor for human non-cardiac gastric cancerA
The risk for gastric cancer development depends on bacterial virulence factorsA
The risk for gastric cancer development depends on host genetic factorsB
Environmental factors contribute to the risk of gastric cancerA
Evidence for H pylori as an important factor for gastric cancer development is shown by experimental animal modelsB
Eradication of H pylori prevents development of pre-neoplastic changes of the gastric mucosa1bA
Eradication of H pylori has the potential to reduce the risk of gastric cancer development1cB
The optimal time to eradicate H pylori is before pre-neoplastic conditions (atrophy, intestinal metaplasia) are present, probably in early adulthood1bA
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*2B
The potential for gastric cancer prevention on a global scale is restricted by currently available treatments1bA
New treatments are required for a global strategy of eradication to prevent gastric cancerA
H pylori eradication for gastric cancer prevention in populations at risk should he evaluated and considered2aB