Which diseases should be treated for Helicobacter pylori infection?

A opinion-forming meeting of gastroenterologists from European countries was held in Maastricht in September 1996, organised by the European Helicobacter Pylori Clinical Study Group. The Maastricht Consensus Report published at this meeting sets out the diseases in which Helicobacter pylori infection should be treated in Europe.

Table 15. Recommendation of the Maastricht Consensus Report on the eradication treatment of Helicobacter pylori (12-13 September 1996)
Disease	Proposal from	Scientific data
Gastric and duodenal ulcers (chronic and acute)	proposed	Clear
MALT-nyirokdaganatok	proposed	Clear
Severe gastritis	proposed	supported by
After surgery for early stomach cancer	proposed	supported by
Non-ulcerative indigestion	councillor	dubious
Stomach cancer in the patient's family	councillor	dubious
Long-term PPI treatment for oesophageal reflux disease	councillor	supported by
Treatment with non-steroidal anti-inflammatory drugs	councillor	dubious
After surgery for ulcer disease	councillor	supported by
Symptom-free individuals	insecure	dubious
In diseases outside the alimentary canal	insecure	dubious

Table 15 summarises the proposals of the Maastricht Consensus Conference. The meeting distinguished 3 grades of treatment for the different pathologies: a) strongly recommended; b) advisable; c) uncertain. The existence of scientific data to support the argumentation for the different diseases was also indicated in 3 grades: 1. clear; 2. supported; 3. doubtful.
The Virginia Report was the official opinion of US gastroenterologists on this issue in 1997. It differed from the Maastricht Consensus on two points:

1. gave priority to two-week treatment instead of one-week treatment
2. acknowledged the place of ranitidine bismuth citrate among the first-line eradication treatments of choice.

Taking into account these recommendations, the Hungarian Gastroenterology Professional Committee has identified the need for eradication of Helicobacter pylori in the following points:
Bacterial eradication is strongly recommended in duodenal and gastric ulcers, in low-malignant MALT lymphoma (a cancer of the mucosal lymphatic system), in atrophic gastritis (an atrophic gastritis of the gastric mucosa), following surgery for gastric cancer, in first-degree relatives of gastric cancer patients, or at the patient's request.
It is recommended for the treatment of bacterial infection in functional dyspepsia (a digestive disorder without organ abnormalities), gastro-oesophageal reflux disease and before starting long-term non-steroidal anti-inflammatory drug (NSAID) treatment.

Helicobacter pylori infection can be treated with a combination of antibiotics and antacids. However, it is important to know that the success rate for eradication of the bacteria is 75% for first-line treatment, 36% for second-line treatment and 20% for third-line treatment at best. The bismuth-containing preparations included in the international recommendations are currently not available in the factory but only in the so-called magistral form. This means that they can only be obtained as a solution prepared by a pharmacist according to the doctor's instructions.
As the duration of the antibiotic combination treatments used can vary between 7-14 days, it is strongly recommended to include probiotics (e.g. Normaflor).

In our article we quoted our medical director on several points, Dr.Alajos Takáts: Patient education book on ulcer disease (Springer Publishers, 1998), with updates by the author.