Current concepts in the management of Helicobacter pylori infection -: The Maastricht 2-2000 Consensus Report
Current concepts in the management of Helicobacter pylori infection -: The Maastricht 2-2000 Consensus Report
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DOI：
10.1046/j.1365-2036.2002.01169.x
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发表时间：
2002-02-01
影响因子：
7.6
通讯作者：
Wadström, T
中科院分区：
文献类型：
--
作者：
Malfertheiner, P;Mégraud, F;Wadström, T
自第一份《马斯特里赫特共识报告》发布以来的 4 年里，我们取得了重大进展并获得了新的见解，因此有必要对原始指南进行更新。为了实现这一目标，欧洲幽门螺杆菌研究小组组织了一次由来自世界各地的专家、国家胃肠病学会代表和欧洲全科医生参加的会议，以制定当前幽门螺杆菌感染管理的最新指南。会议于 2000 年 9 月 21 日至 22 日举行。建议对 45 岁以下（年龄界限可能因地区而异）在初级保健中就诊的持续性消化不良成年患者采用“测试和治疗”方法，排除了以胃食管反流病症状为主的患者、非类固醇抗炎药使用者和有警报症状的患者。诊断感染应通过尿素呼气试验或粪便抗原试验。 正如之前的指南，强烈建议所有消化性溃疡患者根除幽门螺杆菌，包括有并发症的患者、低度胃粘膜相关淋巴组织淋巴瘤患者、萎缩性胃炎患者以及胃癌切除术后患者。还强烈建议胃癌患者的一级亲属，并在充分咨询后根据患者的意愿进行治疗。建议根除幽门螺杆菌被认为是功能性消化不良感染患者的适当选择，因为它可以使一部分患者的症状得到长期改善。人们一致认为，在大多数情况下，根除幽门螺杆菌与胃食管反流病的发展无关，并且不会加剧现有的胃食管反流病。人们一致认为，在使用非甾体抗炎药之前根除幽门螺杆菌可以降低消化性溃疡的发生率，但对于接受抗分泌治疗并继续服用非甾体抗炎药的患者来说，并不能促进胃或十二指肠溃疡的愈合。治疗应被视为将一线和二线根除治疗结合在一起考虑的一揽子治疗。一线治疗应采用三联疗法，使用质子泵抑制剂或雷尼替丁柠檬酸铋，联合克拉霉素和阿莫西林或甲硝唑。二线治疗应采用质子泵抑制剂、铋、甲硝唑和四环素四联疗法。如果没有铋剂，二线治疗应采用基于质子泵抑制剂的三联疗法。如果二线四联疗法在初级保健中失败，患者应转诊至专科医生处。随后的故障应由专家根据具体情况进行处理。对于无并发症的十二指肠溃疡患者，根除治疗后不需要进一步抗分泌治疗。成功根除应始终通过尿素呼气试验或基于内窥镜检查的测试（如果临床上有内窥镜检查指征）来确认。如果无法进行尿素呼气测试，则可以选择粪便抗原测试。
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 toot 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, nonsteroidal 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 nonsteroidal 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 nonsteroidal 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 eradication should always be confirmed by urea breath test or an endoscopy-based test if endoscopy is clinically indicated. Stool antigen test is the alternative if urea breath test is not available.