Maastricht VI/Florence Consensus for the treatment of Helicobacter pylori infection: updated recommendations for cancer prevention opportunities

Abstract

For many decades, one of the most relevant issues remains the effectiveness of treatment of diseases associated with Helicobacter pylori (H. pylori) infection, the main goal of which is the prevention of gastric cancer (GC). The basic principles of diagnosis and treatment of helicobacter infection from the standpoint of evidence‑based medicine formulated in the Maastricht Consensus series. The data is constantly updated and refined by experts based on dynamic research. The new Maastricht VI/Florence Consensus clarified a number of provisions that were previously under discussion. One of the main provisions is that infection with H. pylori always causes gastritis regardless of symptoms or complications. Helicobacter gastritis must be excluded before establishing a clinical diagnosis of functional dyspepsia. About 90% of stomach cancer cases are associated with H. pylori. It is the the main etiological factor of gastric adenocarcinoma, including proximal gastric cancer. Eradication of H. pylori provides an opportunity for cancer prevention at any age in adults, but its effectiveness decreases with age. Therefore, carrying out the timely and effective eradication allows preventing negative consequences in H. pylori — infected patients. In the modern algorithm of eradication therapy in accordance with the Maastricht VI/Florence consensus, preference has been given to quadruple therapy with the use of bismuth drugs. The value of triple therapy with clarithromycin has decreased. There is a rapid increase in the resistance of H. pylori to fluoroquinolones. Bismuth‑containing quadruple therapy with amoxicillin and tetracycline and triple therapy with rifabutin are among the final eradication protocols. Research is underway on new candidate molecules for inclusion in antihelicobacter therapy regimens. Further research will need to optimize new opportunities to improve eradication efficiency, particularly in non‑Asian populations. We hope that the publication of this important international consensus document will allow practicing doctors to use the knowledge of modern gastroenterology and increase the percentage of effective cancer prevention in Ukraine.