Key points from the revised Maastricht Consensus Report: the impact on general practice.
The Maastricht 2 Consensus Report features evidence-based recommendations for the management of Helicobacter pylori infection. Strongly recommended indications for H. pylori eradication include duodenal and gastric ulcer, mucosa-associated lymphoid tissue lymphoma, atrophic gastritis, post gastric cancer resection, first-degree relation to gastric cancer patients, and patient's wishes. Advisable indications include functional dyspepsia, with the statement that eradication can lead to long-term improvement of symptoms in a subset of patients. Because H. pylori eradication does not cause gastro-oesophageal reflux disease (GORD) in most patients, or exacerbate existing GORD, H. pylori should be eradicated in patients requiring long-term acid suppression. Also advisable is H. pylori eradication before administration of non-steroidal anti-inflammatory drugs (NSAIDs), although this alone may be insufficient to reduce recurrent bleeding or enhance ulcer healing in patients receiving antisecretory therapy who continue to take NSAIDs. Maastricht 2 also introduced the concept of the 'treatment package' that considers first- and second-line eradication therapies together. A 'search and treat' strategy should be considered in patients with peptic ulcers; for patients with uncomplicated duodenal ulcer, administration of proton pump inhibitors can be limited to the period of antibiotic treatment.
Bazzoli
F
F
Department of Internal Medicine and Gastroenterology, University of Bologna, Italy. bazzoli@alma.unibo.it
D004415:Dyspepsia / Q000188:drug therapy / Q000382:microbiology*; D005194:Family Practice; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D017410:Practice Guidelines as Topic; D054328:Proton Pump Inhibitors
D054328:Proton Pump Inhibitors