Management ofHelicobacter pyloriinfection: the Maastricht VI/Florence consensus report

Abstract

Helicobacter pyloriInfection is formally recognised as an infectious disease, an entity that is now included in the International Classification of Diseases 11th Revision. This in principle leads to the recommendation that all infected patients should receive treatment. In the context of the wide clinical spectrum associated with Helicobacter pylori gastritis, specific issues persist and require regular updates for optimised management.The identification of distinct clinical scenarios, proper testing and adoption of effective strategies for prevention of gastric cancer and other complications are addressed. H. pylori treatment is challenged by the continuously rising antibiotic resistance and demands for susceptibility testing with consideration of novel molecular technologies and careful selection of first line and rescue therapies. The role of H. pylori and antibiotic therapies and their impact on the gut microbiota are also considered.Progress made in the management of H. pylori infection is covered in the present sixth edition of the Maastricht/Florence 2021 Consensus Report, key aspects related to the clinical role of H. pylori infection were re-evaluated and updated. Forty-one experts from 29 countries representing a global community, examined the new data related to H. pylori infection in five working groups: (1) indications/associations, (2) diagnosis, (3) treatment, (4) prevention/gastric cancer and (5) H. pylori and the gut microbiota. The results of the individual working groups were presented for a final consensus voting that included all participants. Recommendations are provided on the basis of the best available evidence and relevance to the management of H. pylori infection in various clinical fields.

Efficacy and Safety of Polaprezinc-Based Therapy versus the Standard Triple Therapy for Helicobacter pylori Eradication: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Regarding the status of high antimicrobial agents’ resistance, implementing PZN into H. pylori can be beneficial. To clarify, the H. pylori resistance to clarithromycin and metronidazole is currently reported to be ≥ 15% [ 18 , 19 ], leading to a significant drop in the H. pylori eradication rates of triple therapy between 50% and 70% [ 18 , 19 ], which is significantly lower than the recommended ITT Maastricht H. pylori eradication rate of >80% [ 15 ]. Accordingly, PZN regimen can be effectively used for H. pylori with an ITT H. pylori eradication rate of 80.4%.…”

“…The current frontline recommended regimen includes typical triple therapy (proton pump inhibitor (PPI), clarithromycin, and amoxicillin or metronidazole) or bismuth-based quadruple therapy (PPI or H2 receptor antagonists, metronidazole, tetracycline, and bismuth) and other antibiotic-based options [ 14 , 15 , 16 ]. With the global development of antibiotic resistance, the diminished efficacy of clarithromycin, metronidazole, and levofloxacin is reaching an alarming level of 15% [ 17 , 18 , 19 ].…”

Editorial: The interactions between gastrointestinal microbiota and Helicobacter pylori in diseases

“…H. pylori was defined as a carcinogen by the World Health Organization in 1994 and the U.S. Department of Health and Human Services in 2021. According to Maastricht VI/Florence consensus report , H. pylori infection is a primary cause for the development of GC, and H. pylori eradication prior to the stage of chronic atrophic gastritis is the most effective for the prevention of GC ( Malfertheiner et al., 2022 ). It has been documented that the occurrence of spontaneous atrophic gastritis and gastrointestinal intraepithelial neoplasia (GIN) was not developed in germ-free (GF) transgenic insulin-gastrin (INS-GAS) mice by 13 months of age.…”

“…H. pylori infection was also shown to influence the composition, diversity and interactions of gastrointestinal microbiota. Bismuth-containing quadruple therapy was recommended as the first-line treatment of H. pylori infection in an era of increasing antibiotic resistance ( Malfertheiner et al., 2022 ). The proton pump inhibitor, antibiotics and bismuth used in the regimens could induce the disruption of the microbiota in the short-term ( Liou et al., 2019 ).…”

Eficacia de las terapias duales vs. cuadriterapias en la erradicación de Helicobacter pylori en América Latina

“…Hay que considerar que, si se usa CLA o LEVO, debe existir una resistencia reportada en el país < 15%; incluir bismuto si se usan dos antibióticos y considerar tetraciclina en segunda línea. En el caso del consenso de Maastricht, 10 se recomiendan esquemas con base en LEVO o rifabutina para esquemas de segunda línea, pero consideramos que los esquemas basados en LEVO, deben ser utilizados con cautela, debido a que su prescripción para el tratamiento de infecciones del tracto urinario, ha inducido una resistencia creciente, en particular en mujeres mayores de 60 años 12 y, al cabo de unos años de uso masivo, podríamos ver una caída de la tasa de erradicación de H. pylori en esquemas basados en LEVO, como sucedió con la TTE con CLA en el pasado.…”