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[Helicobacter pylori infection. The Spanish consensus report. The Spanish Consensus Conference Group]
R Sainz1, F Borda, E Domínguez
1Servicio de Aparato Digestivo, Hospital Clínico, Zaragoza, España.
Objectives:
taking into account the small amount of infection eradication treatments carried out in our country and some characteristics arising from the resistances to some antibiotics, the Spanish Club for the Study of Helicobacter pylori decided to organize a Spanish Consensus Conference to clarify the use of the different infection diagnostic tests, to establish the exact indications of its diagnosis and treatment, to recommend the best treatment guidelines for our country and to promote the use of eradication treatments in adequate indications.
Design:
on April 23, 1999 in Madrid, physicians who were experts in infection by Helicobacter pylori representing the different Scientific Societies of our country were gathered. Prior to this, three work areas, diagnosis, indications and treatments, were created and the participants freely joined them. One month before the conference, all of the participants were sent the questions which would be debated. An 80% consensus level, always based on scientific evidence, was required for a recommendation. In the first session, a meeting by work areas was held and in a second session, all of the recommendations were voted on in the meeting of the representatives.
Conclusions:
the conference recommends the eradication of the infection in all the gastric or duodenal ulcers, in the erosive duodenitis, in the MALT lymphomas and in gastrectomized patients due to gastric cancer with residual stomach. In the de novo diagnoses of gastroduodenal ulcer, the rapid test of urease is recommended, and a histological study is recommended only if it is negative. In the case of a history of ulcers and also to know the eradication treatment result, the C13 urea breath test is recommended. The culture is reserved for primary treatment and rescue treatment failures so as to select the adequate antibiotic. The primary treatment regimes recommended for our country mean the combination of amoxicillin, clarithromycin and any proton pump inhibitor or with Ranitidine bismuth citrate. If there is allergy to penicillin, amoxycillin will be substituted by metronidazol.
Insights
This consensus recommends Helicobacter pylori eradication for ulcers and MALT lymphomas. It advises urease testing for new ulcers and C13 urea breath tests for follow-up, with amoxicillin/clarithromycin/PPI as a primary treatment.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Antibiotic resistance necessitates updated Helicobacter pylori (H. pylori) eradication guidelines.
- Limited H. pylori infection eradication treatments in Spain prompted a consensus conference.
Framework:
- Spanish Consensus Conference on H. pylori infection.
- Expert physicians from various scientific societies convened.
- Recommendations based on 80% consensus and scientific evidence.
Implementation:
- Focused on diagnosis, indications, and treatment of H. pylori infection.
- Utilized work areas for diagnosis, indications, and treatments.
- Debated and voted on recommendations in plenary sessions.
Implications:
- Recommends H. pylori eradication for gastric/duodenal ulcers, erosive duodenitis, MALT lymphomas, and post-gastric cancer surgery.
- Suggests rapid urease test for new ulcers, histology if negative.
- Recommends C13 urea breath test for ulcer history and treatment verification.
- Defines primary treatment: amoxicillin, clarithromycin, PPI, or Ranitidine bismuth citrate; metronidazole for penicillin allergy.