Original Paper: The management of Helicobacter pylori infection in primary care Guidelines from the ESPCG

Abstract

Objective: There have been numerous national and international attempts to define the management of H. pylori infection, largely characterised by a consensus approach and a predominantly specialist perspective. Most patients with H. pylori infection are managed in primary care where the approach is patient centred and often symptom based. The aim of this project was to develop evidence-based guidelines that were relevant and valid for general practitioners (GPs) across all of Europe.

Method: A consensus meeting of 48 GPs from nine European countries identified key issues through the structured consideration in small groups of a series of case scenarios. The process was supported by access to national prevalence data, key research literature and on-line databases. It featured an immediate and a later postal feedback round. Consensus scores were calculated for each decision point, together with a rating of the supporting evidence. The output was combined with a systematic review of the literature.

Results: The key guidance points are as follows: 1) Eradication therapy should be considered for patients who consult with recurrent dyspepsia, those with newly diagnosed peptic ulcer disease (PUD), and those with a previous diagnosis of PUD whose symptoms relapse or who require long-term acid suppression therapy. 2) Carbon-13 urea breath test (CUBT) or endoscopy and biopsy are the recommended diagnostic tests for H. pylori infection. CUBT is the most useful test for successful eradication. 3) The recommended eradication therapy is a standard dose of proton pump inhibitor, clarithromycin 500 mg and amoxycillin 1000 mg, all twice daily for seven days. 4) An awareness of local resistance rates for metronidazole and clarithromycin is essential for effective treatment.

Key Words:

• Helicobacter pylori
• guideline
• primary care
• systematic review