Malfertheiner P, Megraud F, Morain CAO, Gisbert JP, Kuipers EJ, Axon AT, Bazzoli F, Gasbarrini A et al. Management of Helicobacter pylori infection—the Maastricht V/Florence Consensus Report // Gut 2016;0:1–25. doi:10.1136/gutjnl-2016-312288.

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Авторы: Malfertheiner P. / Megraud F. / O’Morain C.A. / Gisbert J.P. / Kuipers E.J. / Axon A.T.R. / Bazzoli F. / Gasbarrini A. / Atherton J. / Graham D.Y. / Hunt R.H. / Moayyedi P. / Rokkas T. / Rugge M. / Selgrad M. / Suerbaum S. / Sugano K. / El-Omar E.M.


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Management of Helicobacter pylori infection—the Maastricht V/Florence Consensus Report

P Malfertheiner,1 F Megraud,2 CAO’Morain,3 J P Gisbert,4,5 E J Kuipers,6 A T Axon,7 F Bazzoli,8 A Gasbarrini,9 J Atherton,10 D Y Graham,11 R Hunt,12,13 P Moayyedi,14 T Rokkas,15 M Rugge,16 M Selgrad,17 S Suerbaum,18 K Sugano,19 E M El-Omar,20 on behalf of the European Helicobacter and Microbiota Study Group and Consensus pane

Abstract

Important progress has been made in the management of Helicobacter pylori infection and in this fifth edition of the Maastricht Consensus Report, key aspects related to the clinical role of H. pylori were reevaluated in 2015. In the Maastricht V/Florence Consensus Conference, 43 experts from 24 countries examined new data related to H. pylori in five subdivided workshops: (1) Indications/Associations, (2) Diagnosis, (3) Treatment, (4) Prevention/Public Health, (5) H. pylori and the Gastric Microbiota. The results of the individual workshops were presented to 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 the various clinical scenarios.

Introduction

Nearly 4 years after publication of the Maastricht IV/Florence Consensus Report the content has been updated by maintaining the traditional interval considered appropriate for capturing progress in the field of Helicobacter pylori related clinical issues and adapting the management to current demands.

Among the challenges, the increasing H. pylori resistance to previously efficacious antibiotic regimens is of great concern and requires modification of therapeutic strategies. Furthermore, new studies have been conducted to demonstrate the feasibility and efficacy of primary and secondary gastric cancer prevention. A recent important evolution has taken place by the publication of the Kyoto consensus report. Key outcomes of this consensus report include the designation of H. pylori gastritis as an infectious disease with the recommendation of treatment of all H. pylori infected subjects. This represents a paradigm shift, as the indication for treatment is no longer reserved for patients with clinical manifestations of the infection. In the same consensus, H. pylori gastritis with dyspeptic symptoms was designated as a specific entity outside the ‘umbrella’ definition of functional dyspepsia. Both these aspects have been carefully reexamined. The role of H. pylori infection has also been assessed with the perspective of potential interactions with other microbiota in the upper and lower digestive system, as the gut microbiome has emerged as an essential player in human health and disease. A comprehensive and updated overview on the complexity of gastric functions in health and disease has recently addressed this issue.

The aim of this report is to serve as a state-of-the-art guide for the management of H. pylori infection and related clinical manifestations and also as an inspiration for new clinical research in the area.

In the Maastricht V/Florence Consensus Report 43 experts from 24 countries convened for 2 days for a face-to-face meeting after having been actively involved in a previously started Delphi process as described below.

The working groups were set up according to the following topics:
  • Working group 1: Indications/Associations Working group 2: Diagnosis
  • Working group 3: Treatment
  • Working group 4: Prevention/Public Health Working group 5: H. pylori and the Gastric Microbiota
Methodology

The evidence-based Delphi process developed consensus statements following proposals by designated coordinators. The process allowed individual feedback and changes of views during the process regulated by the coordinators and the consensus chair.

The principal steps in the process were: (a) selection of the consensus group; (b) identification of areas of clinical importance; (c) systematic literature reviews to identify evidence to support each statement, draft statements and discussions supported by the evidence specific to each statement.

Two rounds of voting were conducted.

The delegation was asked to choose one of the fol-lowing ratings for each statement:
  • agree strongly
  • agree with reservation
  • undecided
  • disagree or
  • disagree strongly.
When no strong agreement was reached, the statement was rephrased and the vote was repeated. Evidence-based discussions with key references were provided for each statement on which participants voted. Consensus had to be reached by 80%of respondents who (a) strongly agreed or (b) agreed with reservation.

The level of evidence and strength of the recommendations were completed only after the individual working group meetings. Based on the type of studies, evidence levels and grade of recommendation were either based on the system used in the previous consensus reports (see online supplementary appendix)1 or, if statements were suitable for grade assessment, based on so called PICO questions (PICO: population, intervention, comparator, outcome) they have been graded accordingly.

The Face to Face meeting was held in 8–9 October 2015 and reviewed the statements in individual working groups first which were then presented to all delegates for final voting.

Statements that have passed the 80% consensus threshold are reported in here.



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Статьи на русском языке:

Старостин Б.Д. Лечение Helicobacter руlогі-инфекции - Маастрихсткий V/Флорентийский консенсусный отчет (перевод с комментариями) // Гастроэнтерология Санкт-Петербурга. 2017; (1): 2-22.



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