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lüll Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report Malfertheiner P; Megraud F; O'Morain C; Bazzoli F; El-Omar E; Graham D; Hunt R; Rokkas T; Vakil N; Kuipers EJGut 2007[Jun]; 56 (6): 772-81BACKGROUND: Guidelines on the management of Helicobacter pylori, which cover indications for management and treatment strategies, were produced in 2000. AIMS: To update the guidelines at the European Helicobacter Study Group (EHSG) Third Maastricht Consensus Conference, with emphasis on the potential of H pylori eradication for the prevention of gastric cancer. RESULTS: Eradication of H pylori infection is recommended in (a) patients with gastroduodenal diseases such as peptic ulcer disease and low grade gastric, mucosa associated lymphoid tissue (MALT) lymphoma; (b) patients with atrophic gastritis; (c) first degree relatives of patients with gastric cancer; (d) patients with unexplained iron deficiency anaemia; and (e) patients with chronic idiopathic thrombocytopenic purpura. Recurrent abdominal pain in children is not an indication for a "test and treat" strategy if other causes are excluded. Eradication of H pylori infection (a) does not cause gastro-oesophageal reflux disease (GORD) or exacerbate GORD, and (b) may prevent peptic ulcer in patients who are naive users of non-steroidal anti-inflammatory drugs (NSAIDs). H pylori eradication is less effective than proton pump inhibitor (PPI) treatment in preventing ulcer recurrence in long term NSAID users. In primary care a test and treat strategy using a non-invasive test is recommended in adult patients with persistent dyspepsia under the age of 45. The urea breath test, stool antigen tests, and serological kits with a high accuracy are non-invasive tests which should be used for the diagnosis of H pylori infection. Triple therapy using a PPI with clarithromycin and amoxicillin or metronidazole given twice daily remains the recommended first choice treatment. Bismuth-containing quadruple therapy, if available, is also a first choice treatment option. Rescue treatment should be based on antimicrobial susceptibility. CONCLUSION: The global burden of gastric cancer is considerable but varies geographically. Eradication of H pylori infection has the potential to reduce the risk of gastric cancer development.|*Helicobacter pylori[MESH]|Adult[MESH]|Anti-Bacterial Agents/therapeutic use[MESH]|Child[MESH]|Drug Resistance, Bacterial[MESH]|Dyspepsia/microbiology[MESH]|Gastroesophageal Reflux/microbiology[MESH]|Helicobacter Infections/complications/diagnosis/*drug therapy[MESH]|Humans[MESH]|Lymphoma, B-Cell, Marginal Zone/microbiology[MESH]|Stomach Neoplasms/microbiology/prevention & control[MESH] |