Who Should Be Treated for Helicobacter pylori Infection? A Review of Consensus Conferences and Guidelines
Identifieur interne : 001789 ( Istex/Corpus ); précédent : 001788; suivant : 001790Who Should Be Treated for Helicobacter pylori Infection? A Review of Consensus Conferences and Guidelines
Auteurs : John Lee ; Colm O'MorainSource :
- Gastroenterology [ 0016-5085 ] ; 1997.
English descriptors
Abstract
The publication of the National Institutes of Health Consensus Development Conference guidelines on management of Helicobacter pylori infection in 1994 set a precedence. At present, at least eight European countries have produced national guidelines, and, more recently, the European Helicobacter pylori Study Group also outlined guidelines based on the strength of available evidence. It is generally agreed that H. pylori should be eradicated in peptic ulcer disease. In nonsteroidal anti-inflammatory drug (NSAID)-related ulcers, most countries that considered the issue suggested discontinuing NSAIDs when possible and eradicating H. pylori. The prophylactic eradication of H. pylori was not recommended. A number of panels felt that there was not enough evidence available to recommend eradication of H. pylori in functional dyspepsia, whereas other groups felt that nonulcer dyspepsia, particularly after investigation and with severe or recurrent symptoms, was an indication for eradication therapy. Other conditions (i.e., gastroesophageal reflux disease [GERD] and mucosa-associated lymphoid tissue [MALT] lymphoma) have emerged in this short time as possible indications for H. pylori eradication. There is no evidence that H. pylori infection has a role in the pathogenesis of GERD, but there is evidence suggesting that patients with H. pylori infection who require long-term acid suppression may be at risk of developing atrophic gastritis. The European Helicobacter pylori Study Group has suggested that eradication therapy should be offered to infected family members of patients with gastric cancer. It also recommended that eradication therapy was “strongly recommended” on the basis of “supportive” evidence in gastritis with severe abnormalities and after early resection of early gastric cancer. An “uncertain” recommendation with “equivocal” evidence was given for asymptomatic subjects, extra-alimentary tract disease, the prevention of gastric cancer in the absence of risk factors, and in pediatric patients with recurrent abdominal pain. Despite considerable advances, further research studies are needed to provide definite direction for the treatment of many conditions.
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DOI: 10.1016/S0016-5085(97)80021-2
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<front><div type="abstract">The publication of the National Institutes of Health Consensus Development Conference guidelines on management of Helicobacter pylori infection in 1994 set a precedence. At present, at least eight European countries have produced national guidelines, and, more recently, the European Helicobacter pylori Study Group also outlined guidelines based on the strength of available evidence. It is generally agreed that H. pylori should be eradicated in peptic ulcer disease. In nonsteroidal anti-inflammatory drug (NSAID)-related ulcers, most countries that considered the issue suggested discontinuing NSAIDs when possible and eradicating H. pylori. The prophylactic eradication of H. pylori was not recommended. A number of panels felt that there was not enough evidence available to recommend eradication of H. pylori in functional dyspepsia, whereas other groups felt that nonulcer dyspepsia, particularly after investigation and with severe or recurrent symptoms, was an indication for eradication therapy. Other conditions (i.e., gastroesophageal reflux disease [GERD] and mucosa-associated lymphoid tissue [MALT] lymphoma) have emerged in this short time as possible indications for H. pylori eradication. There is no evidence that H. pylori infection has a role in the pathogenesis of GERD, but there is evidence suggesting that patients with H. pylori infection who require long-term acid suppression may be at risk of developing atrophic gastritis. The European Helicobacter pylori Study Group has suggested that eradication therapy should be offered to infected family members of patients with gastric cancer. It also recommended that eradication therapy was “strongly recommended” on the basis of “supportive” evidence in gastritis with severe abnormalities and after early resection of early gastric cancer. An “uncertain” recommendation with “equivocal” evidence was given for asymptomatic subjects, extra-alimentary tract disease, the prevention of gastric cancer in the absence of risk factors, and in pediatric patients with recurrent abdominal pain. Despite considerable advances, further research studies are needed to provide definite direction for the treatment of many conditions.</div>
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<head><ce:title>Who Should Be Treated for <ce:italic>Helicobacter pylori</ce:italic>
Infection? A Review of Consensus Conferences and Guidelines</ce:title>
<ce:author-group><ce:author><ce:given-name>John</ce:given-name>
<ce:surname>Lee</ce:surname>
</ce:author>
<ce:author><ce:given-name>Colm</ce:given-name>
<ce:surname>O'Morain</ce:surname>
<ce:cross-ref refid="cor1"><ce:sup>a</ce:sup>
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<ce:e-address type="email">comgast@indigo.ie</ce:e-address>
</ce:author>
<ce:affiliation><ce:textfn>Department of Gastroenterology, Meath/Adelaide Hospitals, Trinity College, Dublin, Ireland</ce:textfn>
</ce:affiliation>
<ce:correspondence id="cor1"><ce:label>a</ce:label>
<ce:text>Address requests for reprints to: Colm O'Morain, M.D., Department of Gastroenterology, Meath Hospital, Heytesbury Street, Dublin 8, Ireland. fax: (353) 1-473-0857.</ce:text>
</ce:correspondence>
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<ce:date-received day="30" month="6" year="1997"></ce:date-received>
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<ce:abstract id="ab1"><ce:abstract-sec><ce:simple-para id="SP0005">The publication of the National Institutes of Health Consensus Development Conference guidelines on management of <ce:italic>Helicobacter pylori</ce:italic>
infection in 1994 set a precedence. At present, at least eight European countries have produced national guidelines, and, more recently, the European <ce:italic>Helicobacter pylori</ce:italic>
Study Group also outlined guidelines based on the strength of available evidence. It is generally agreed that <ce:italic>H. pylori</ce:italic>
should be eradicated in peptic ulcer disease. In nonsteroidal anti-inflammatory drug (NSAID)-related ulcers, most countries that considered the issue suggested discontinuing NSAIDs when possible and eradicating <ce:italic>H. pylori</ce:italic>
. The prophylactic eradication of <ce:italic>H. pylori</ce:italic>
was not recommended. A number of panels felt that there was not enough evidence available to recommend eradication of <ce:italic>H. pylori</ce:italic>
in functional dyspepsia, whereas other groups felt that nonulcer dyspepsia, particularly after investigation and with severe or recurrent symptoms, was an indication for eradication therapy. Other conditions (i.e., gastroesophageal reflux disease [GERD] and mucosa-associated lymphoid tissue [MALT] lymphoma) have emerged in this short time as possible indications for <ce:italic>H. pylori</ce:italic>
eradication. There is no evidence that <ce:italic>H. pylori</ce:italic>
infection has a role in the pathogenesis of GERD, but there is evidence suggesting that patients with <ce:italic>H. pylori</ce:italic>
infection who require long-term acid suppression may be at risk of developing atrophic gastritis. The European <ce:italic>Helicobacter pylori</ce:italic>
Study Group has suggested that eradication therapy should be offered to infected family members of patients with gastric cancer. It also recommended that eradication therapy was “strongly recommended” on the basis of “supportive” evidence in gastritis with severe abnormalities and after early resection of early gastric cancer. An “uncertain” recommendation with “equivocal” evidence was given for asymptomatic subjects, extra-alimentary tract disease, the prevention of gastric cancer in the absence of risk factors, and in pediatric patients with recurrent abdominal pain. Despite considerable advances, further research studies are needed to provide definite direction for the treatment of many conditions.</ce:simple-para>
</ce:abstract-sec>
</ce:abstract>
<ce:keywords class="abr"><ce:section-title>Abbreviations used in this paper</ce:section-title>
<ce:keyword><ce:text>EHPSG</ce:text>
<ce:keyword><ce:text>European <ce:italic>Helicobacter pylori</ce:italic>
Study Group</ce:text>
</ce:keyword>
</ce:keyword>
<ce:keyword><ce:text>GERD</ce:text>
<ce:keyword><ce:text>gastroesophageal reflux disease</ce:text>
</ce:keyword>
</ce:keyword>
<ce:keyword><ce:text>MALT</ce:text>
<ce:keyword><ce:text>mucosa-associated lymphoid tissue</ce:text>
</ce:keyword>
</ce:keyword>
</ce:keywords>
</head>
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<mods version="3.6"><titleInfo lang="en"><title>Who Should Be Treated for Helicobacter pylori Infection? A Review of Consensus Conferences and Guidelines</title>
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<name type="personal"><namePart type="given">John</namePart>
<namePart type="family">Lee</namePart>
<affiliation>Department of Gastroenterology, Meath/Adelaide Hospitals, Trinity College, Dublin, Ireland</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">Colm</namePart>
<namePart type="family">O'Morain</namePart>
<affiliation>Department of Gastroenterology, Meath/Adelaide Hospitals, Trinity College, Dublin, Ireland</affiliation>
<affiliation>E-mail: comgast@indigo.ie</affiliation>
<description>Address requests for reprints to: Colm O'Morain, M.D., Department of Gastroenterology, Meath Hospital, Heytesbury Street, Dublin 8, Ireland. fax: (353) 1-473-0857.</description>
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<abstract>The publication of the National Institutes of Health Consensus Development Conference guidelines on management of Helicobacter pylori infection in 1994 set a precedence. At present, at least eight European countries have produced national guidelines, and, more recently, the European Helicobacter pylori Study Group also outlined guidelines based on the strength of available evidence. It is generally agreed that H. pylori should be eradicated in peptic ulcer disease. In nonsteroidal anti-inflammatory drug (NSAID)-related ulcers, most countries that considered the issue suggested discontinuing NSAIDs when possible and eradicating H. pylori. The prophylactic eradication of H. pylori was not recommended. A number of panels felt that there was not enough evidence available to recommend eradication of H. pylori in functional dyspepsia, whereas other groups felt that nonulcer dyspepsia, particularly after investigation and with severe or recurrent symptoms, was an indication for eradication therapy. Other conditions (i.e., gastroesophageal reflux disease [GERD] and mucosa-associated lymphoid tissue [MALT] lymphoma) have emerged in this short time as possible indications for H. pylori eradication. There is no evidence that H. pylori infection has a role in the pathogenesis of GERD, but there is evidence suggesting that patients with H. pylori infection who require long-term acid suppression may be at risk of developing atrophic gastritis. The European Helicobacter pylori Study Group has suggested that eradication therapy should be offered to infected family members of patients with gastric cancer. It also recommended that eradication therapy was “strongly recommended” on the basis of “supportive” evidence in gastritis with severe abnormalities and after early resection of early gastric cancer. An “uncertain” recommendation with “equivocal” evidence was given for asymptomatic subjects, extra-alimentary tract disease, the prevention of gastric cancer in the absence of risk factors, and in pediatric patients with recurrent abdominal pain. Despite considerable advances, further research studies are needed to provide definite direction for the treatment of many conditions.</abstract>
<subject lang="en"><genre>Abbreviations used in this paper</genre>
<topic>EHPSG : European Helicobacter pylori Study Group</topic>
<topic>GERD : gastroesophageal reflux disease</topic>
<topic>MALT : mucosa-associated lymphoid tissue</topic>
</subject>
<relatedItem type="host"><titleInfo><title>Gastroenterology</title>
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<originInfo><dateIssued encoding="w3cdtf">199712</dateIssued>
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<identifier type="ISSN">0016-5085</identifier>
<identifier type="PII">S0016-5085(97)X8001-1</identifier>
<part><date>199712</date>
<detail type="volume"><number>113</number>
<caption>vol.</caption>
</detail>
<detail type="issue"><number>6</number>
<caption>no.</caption>
</detail>
<detail type="supplement"><number>S</number>
<caption>Suppl.</caption>
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<extent unit="issue pages"><start>S1</start>
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