Bibliographic Details
| Title: |
Current concepts in the management of Helicobacter pylon infection: the Maastricht III Consensus Report. |
| Authors: |
Malfertheiner, P., Megraud, F., O'Morain, C., Bazzoli, F., El-Omar, E., Graham, D., Hunt, R., Rokkas, I., Vakil, N., Kuipers, E. J. |
| Source: |
Gut (0017-5749); Jun2007, Vol. 56 Issue 6, p772-781, 10p, 6 Charts |
| Subject Terms: |
Helicobacter pylori, Helicobacter diseases, Stomach cancer, Peptic ulcer, Gastritis, Thrombopenic purpura, Gastric mucosa, Abdominal pain |
| Abstract: |
Background: Guidelines on the management of Helicobacterpylori, 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 pylon eradication for the prevention of gastric cancer. Results: Eradication of H pylon 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; (c) 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 pylon 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 pylon 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 pylon 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 pylon infection has the potential to reduce the risk of gastric cancer development. [ABSTRACT FROM AUTHOR] |
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| Database: |
Complementary Index |