The Maastricht recommendations and their impact on general practice.

Abstract

At a meeting organized in Maastricht by the European Helicobacter Pylori Study Group, European consensus guidelines for the treatment of Helicobacter pylori were established by determining what relevant information from research could be translated into clinical practice. Many of the patients infected with H. pylori can be diagnosed and treated in the primary care setting. Dyspeptic patients under 45 years of age, with no alarm symptoms or risk of gastric or oesophageal malignancy, can be tested non-invasively and treated in the primary care setting. For diagnosis, a validated non-invasive method is recommended, such as the 13C-urea breath test or laboratory-based serology if properly validated in the region in which it is used. The meeting strongly recommended that all patients with peptic ulcer are treated with eradication therapy. Patients over the age of 45 years and those with alarm symptoms should be referred with no hesitation to the specialist After full consideration of the treatments used to date, it was strongly recommended that treatment should be with proton-pump inhibitor-based triple therapy, consisting of a proton-pump inhibitor and two of the following: clarithromycin, a nitroimidazole (metronidazole or tinidazole) and amoxycillin. The evidence supporting the use of these therapies has been substantiated in large clinical trials that were recently completed.