Guidelines for diagnosis

An infection with Helicobacter pylori is generally associated with a range of serious consequences for the health of the affected individual. There is a correlation between H.pylori infection and gastric/duodenal ulcer and malignant gastric illnesses. This raises the question as to who needs to undergo diagnosis for H.pylori, and if found positive, which treatment to receive.

A report delivered by experts at the Maastricht IV/Florence Consensus Conference (The European Helicobacter Study Group (EHSG). Management of Helicobacter pylori infection – the Maastricht IV/ Florence Consensus Report. Gut 2012; 61:646-664.) included the following statements for the management of Helicobacter pylori infection:

  • A test-and -treat strategy is appropriate for uninvestigated dyspepsia in populations where the H.pylori prevalence is high (≥ 20 %). This approach is subject to local cost-benefit considerations and is not applicable to patients with alarm symptoms such as weight loss, dysphagia, GI bleeding, abdominal mass and iron deficient anaemia.
  • The main non-invasive tests that can be used for the test-and-treat strategy are the UBT and monoclonal stool antigen tests.
  • H.pylori eradication produces long-term relief of dyspepsia in one of 12 patients with H.pylori and functional dyspepsia; this is better than any other treatment.
  • Long-term treatment with PPIs in H.pylori-positive patients is associated with the development of a corpus-predominant gastritis. This accelerates the process of loss of specialized glands, leading to atrophic gastritis.
  • Eradication of H.pylori in patients receiving long-term PPIs heals gastritis and prevents the progression to atrophic gastritis.