Global consensus update for managing Helicobacter pylori infection: critical issues from the United States

Abstract

A global consensus concerning the management of Helicobacter pylori infection may be difficult to reach. The level of concern about the organism, as well as guidelines for the management of the infection, vary throughout the world. Differences in levels of concern are due to the varied prevalence of infection and infection-related clinical outcomes from region to region. In part, differences in management result from variations in local standards of practice, strong ‘expert’ opinions, or application of ‘eminence-based’ rather then evidence-based principles. This is also the case in the United States where H. pylori management guidelines have evolved since the original 1994¹ NIH Consensus Report, the 1997 American Digestive Health Foundation recommendations² and the most recent strategies proposed by the American College of Gastroenterology (ACG) in 1998³. Despite the availability of these published and widely publicized management approaches, health-care providers often disagree with, choose to ignore or are unaware of specific recommendations. Re-emphasizing existing H. pylori management strategies that are based on strong evidence would undoubtedly benefit infected individuals in the United States more than expanding treatment recommendations to include less substantiated indications. The prevalence of infection and its associated diseases, the relative seriousness of infection-related conditions and their expected outcome following eradication, the availability, cost and accuracy of testing, and the cost and effectiveness of treatment vary considerably throughout the world, and even regionally within countries such as the United States. Therefore, no single management approach would be expected to be universally applicable. Nevertheless, it should be possible to develop a global management scheme specific enough to impact clinically important infection-related conditions, yet general enough to account for regional nuances in the prevalence of disease and standards of practice.