Significant progress and new insights have been gained in the 4 years since the first Maastricht Consensus Report, necessitating an update of the original guidelines. To achieve this, the European Helicobacter Pylori Study Group organized a meeting of specialists and experts from around the world, representatives from National Gastroenterology Societies and general practitioners from Europe to establish updated guidelines on the current management of Helicobacter pylori infection. The meeting took place on 21–22 September 2000. A ‘test and treat’ approach is recommended in adult patients under the age of 45 years (the age cut‐off may vary locally) presenting in primary care with persistent dyspepsia, having excluded those with predominantly gastro‐oesophageal reflux disease symptoms, non‐steroidal anti‐inflammatory drug users and those with alarm symptoms. Diagnosis of infection should be by urea breath test or stool antigen test. As in the previous guidelines, the eradication of H. pylori is strongly recommended in all patients with peptic ulcer, including those with complications, in those with low‐grade gastric mucosa‐associated lymphoid tissue lymphoma, in those with atrophic gastritis and following gastric cancer resection. It is also strongly recommended in patients who are first‐degree relatives of gastric cancer patients and according to patients’ wishes after full consultation. It is advised that H. pylori eradication is considered to be an appropriate option in infected patients with functional dyspepsia, as it leads to long‐term symptom improvement in a subset of patients. There was consensus that the eradication of H. pylori is not associated with the development of gastro‐oesophageal reflux disease in most cases, and does not exacerbate existing gastro‐oesophageal reflux disease. It was agreed that the eradication of H. pylori prior to the use of non‐steroidal anti‐inflammatory drugs reduces the incidence of peptic ulcer, but does not enhance the healing of gastric or duodenal ulcer in patients receiving antisecretory therapy who continue to take non‐steroidal anti‐inflammatory drugs. Treatment should be thought of as a package which considers first‐ and second‐line eradication therapies together. First‐line therapy should be with triple therapy using a proton pump inhibitor or ranitidine bismuth citrate, combined with clarithromycin and amoxicillin or metronidazole. Second‐line therapy should use quadruple therapy with a proton pump inhibitor, bismuth, metronidazole and tetracycline. Where bismuth is not available, second‐line therapy should be with proton pump inhibitor‐based triple therapy. If second‐line quadruple therapy fails in primary care, patients should be referred to a specialist. Subsequent failures should be handled on a case‐by‐case basis by the specialist. In patients with uncomplicated duodenal ulcer, eradication therapy does not need to be followed by further antisecretory treatment. Successful eradica‐ tion should always be confirmed by urea breath test or an endoscopy‐based test i...

SUMMARYAim: To determine the prevalence, symptom pattern and impact of the irritable bowel syndrome, across eight European countries, using a standardized methodology. Methods: A community survey of 41 984 individuals was performed using quota sampling and random digit telephone dialling to identify those with diagnosed irritable bowel syndrome or those meeting diagnostic criteria, followed by in-depth interviews. Results: The overall prevalence was 11.5% (6.2-12%); 9.6% had current symptoms, 4.8% had been formally diagnosed and a further 2.9%, 4.2% and 6.5% met the Rome II, Rome I or Manning criteria, respectively. Bowel habit classification varied by criteria: 63% had an 'alternating' bowel habit by Rome II vs. 21% by selfreport. On average, 69% reported symptoms lasting for 1 h, twice daily, for 7 days a month. Irritable bowel syndrome sufferers reported more peptic ulcer (13% vs. 6%), reflux (21% vs. 7%) and appendectomy (17% vs. 11%), but not hysterectomy, cholecystectomy or bladder procedures. Ninety per cent had consulted in primary care and 17% in hospital; 69% had used medication. Irritable bowel syndrome substantially interfered with lifestyle and caused absenteeism. Conclusions: Irritable bowel syndrome is common with major effects on lifestyle and health care. The majority of cases are undiagnosed and the prevalence varies strikingly between countries. Diagnostic criteria are associated with varying prevalences and bowel habit sub-types. This limits their utility in clinical practice and the transferability of research findings using them.

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Summary Background : The impact of irritable bowel syndrome, a gastrointestinal motility disorder, is underestimated and poorly quantified, as clinicians may see only a minority of sufferers. Aim : To determine the prevalence, symptom patterns and impact of irritable bowel syndrome in the US. Methods : This two‐phase community survey used quota sampling and random‐digit telephone dialling (screening interview) to identify individuals with medically diagnosed irritable bowel syndrome or individuals not formally diagnosed, but fulfilling irritable bowel syndrome diagnostic criteria (Manning, Rome I or II). Information on irritable bowel syndrome symptoms, general health status, lifestyle and impact of symptoms on individuals’ lives was collected using in‐depth follow‐up interviews. Data were also collected for healthy controls identified in the screening interviews. Results : The total prevalence of irritable bowel syndrome in 5009 screening interviews was 14.1% (medically diagnosed: 3.3%; undiagnosed, but meeting irritable bowel syndrome criteria: 10.8%). Abdominal pain/discomfort was the most common symptom prompting consultation. Most sufferers (74% medically diagnosed; 63% undiagnosed) reported alternating constipation and diarrhoea. Previously diagnosed gastrointestinal disorders occurred more often in sufferers than non‐sufferers. Irritable bowel syndrome sufferers had more days off work (6.4 vs. 3.0) and days in bed, and reduced activities to a greater extent than non‐sufferers. Conclusions : Most (76.6%) irritable bowel syndrome sufferers in the US are undiagnosed. Irritable bowel syndrome has a substantial impact on sufferers’ well‐being and health, with considerable socioeconomic consequences.

Background: Inflammatory bowel diseases have significant long‐term morbidity and healthcare resource consequences. Studies based on secondary care records may have underestimated the contribution of general practitioners (GPs) to its management. Aims: To describe the epidemiology and management of inflammatory bowel disease using GP records as the primary data source. Methods: A systematic search of GP clinical records in northern England, identifying cases of inflammatory bowel disease, patient consultation behaviour, prescribing patterns, and extent of specialist care. Results: In a population of 135 723, the incidence of ulcerative colitis was 13.9/100 000 per year (CI: 7.5–20.3) and for Crohn’s disease 8.3/100 000 per year (CI: 3.4–13.2). The age–sex adjusted point prevalence for ulcerative colitis on 1st January 1995 was 243.4/100 000 (CI: 217.4–269.4) and for Crohn’s disease 144.8/100 000 (CI: 124.8–168.8). The mean number of consultations (s.d.) with specialists and GPs were similar, both in the first 12 months after referral (specialists 3.94 ± 3.15, GPs 3.34 ± 3.55) and in the most recent 12 months (1.02 ± 2.02, 1.04 ± 2.04). Only 29.9% of all patients were definitely under specialist care. Conclusions: Prevalence rates, but not incidence rates, for inflammatory bowel disease are substantially higher than previously described in UK populations. General practitioners make a significant contribution to meeting the healthcare needs of these patients.