Indications, diagnostic tests and Helicobacter pylori eradication therapy: Recommendations by the 2nd Spanish Consensus Conference

Abstract

The results of the 2 nd Spanish Consensus Conference for appropriate practice regarding indications for eradication, diagnostic tests, and therapy regimens for Helicobacter pylori infection are summarized. The Conference was based on literature searches in Medline, abstracts from three international meetings, and abstracts from national meetings. Results were agreed upon and approved by the whole group. Results are supplemented by evidence grades and recommendation levels according to the classification used in the Clinical Practice Guidelines issued by Cochrane Collaboration. Convincing indications (peptic ulcer, duodenal erosions with no history of ASA or NSAIDs, MALT lymphoma), and not so convincing indications (functional dyspepsia, patients receiving lowdose ASA for platelet aggregation, gastrectomy stump in patients operated on for gastric cancer, first-degree relatives of patients with gastric cancer, lymphocytic gastritis, and Ménétrier's disease) for H. pylori eradication are discussed. Diagnostic recommendations for various clinical conditions (peptic ulcer, digestive hemorrhage secondary to ulcer, eradication control, patients currently or recently receiving antibiotic or antisecretory therapy), as well as diagnostic tests requiring biopsy collection (histology, urease fast test, and culture) when endoscopy is needed for clinical diagnosis, and non-invasive tests requiring no biopsy collection (13 C-urea breath test, serologic tests, and fecal antigen tests) when endoscopy is not needed are also discussed. As regards treatment, first-choice therapies (triple therapy using a PPI and two antibiotics), therapy length, quadruple therapy, and a number of novel antibiotic options as "rescue" therapy are prioritized, the fact that prolonging PPI therapy following effective eradication is unnecessary for patients with duodenal ulcer but not for all gastric ulcers is documented, the fact that cultures and antibiograms are not needed for all eradicating therapies is indicated, and finally the test and treat strategy is considered adequate, however only under certain circumstances.

Comparison of three methods based on endoscopic gastric biopsies for diagnosis of Helicobacter pylori active infection in a clinical setting

“…This finding supports the recommendation previously made by other authors (6,13) , i.e. two biopsies (one of antrum and one of corpus) reduce the risk of false-negative results of anatomopathologic examination.…”

III Conferencia Española de Consenso sobre la infección por Helicobacter pylori

“…Se han organizado hasta el momento diversas conferencias de consenso sobre el diagnóstico y tratamiento de la infección por este microorganismo en América, Europa y Asia. En el año 1999 se organizó la primera Conferencia Española de Consenso sobre la infección por H. pylori 1,2 y en 2004, la segunda 3,4 . Ya en aquel momento se destacó que el rápido avance de los conocimientos hace que este tipo de reuniones de consenso pueda perder actualidad en periodos relativamente breves, por lo que se preveía su actualización permanente.…”

Primary MALT lymphomas of the stomach: A pathological study of 18 cases

“…In addition, others described mixed grade (LG B-cell lymphoma of MALT with a focal HG component) (22). HG gastric MALT lymphomas were reported to be more frequent than LG lesions (5,19,23). In Nakamura's study, among 233 cases, 43% of the cases were HG, 30% were LG, 12% were LG with focal HG, 6% other B, 6% other T-cell lymphomas (9).…”

“…To assess changes on repeat biopsy, the confidence in a diagnosis of lymphoma was expressed on a scale of 0-5 (15). Patients were staged by physical and ORL examinations, blood tests, ultrasonography, whole-body computed tomography (CT) scanning, and endoscopic ultrasonography of the gastric lesion, according to modified Ann Arbor classification criteria (17)(18)(19)(20).…”