幽门螺杆菌感染的处理-马斯特里赫特IV-佛罗伦萨共识报告(Maastricht-4)

Management of Helicobacter pylori infection－the Maastricht IV/ Florence Consensus Report

幽门螺杆菌感染的处理－

马斯特里赫特IV/佛罗伦萨共识报告

Malfertheiner P, et al. Gut 2012; 61: 646-664

（上海交通大学医学院附属仁济医院消化科刘文忠教授译）

WORKSHOP 1 工作小组1

(Indications and contraindications for diagnosis and treatment)

(诊断、治疗指证和反指证)

Statement 1: A test-and-treat strategy is appropriate for uninvestigated dyspepsia in populations where the H. pylori prevalence is high (>20%). This approach is subject to local cost-benefit considerations and is not applicable to patients with alarm symptoms, or older patients (age to be determined locally according to cancer risk) [Evidence level:1a, Grade of recommendation: A]

检测和治疗策略对幽门螺杆菌感染率高于20%人群中未经调查的消化不良者是合适的。这一方法应考虑当地的费用-效益比，不适用于有报警症状患者或老年患者（年龄应根据当地癌症风险确定）[证据水平:1a, 推荐级别: A] Statement 2: The main non-invasive tests that can be used for the test-and-treat strategy are the UBT and monoclonal stool antigen tests. Certain validated serological tests can also be used.[2a,B]

用于检测和治疗策略的主要非侵入性试验是尿素呼气试验（UBT）和单克隆粪便抗原试验。也可用某些已经过验证的血清学试验。[2a，B]

Statement 3: H. pylori eradication produces long-term relief of dyspepsia in one of 12 patients with H.pylori and functional dyspepsia; this is better than any other treatment.[1a,A]

根除幽门螺杆菌可使1/12幽门螺杆菌阳性功能性消化不良患者有长期的症状缓解，这一疗效优于其他任何治疗。[1a,A]

Statement 4: H. pylori can increase or decrease acid secretion depending on the

intragastric distribution of inflammation.[2b,B]

幽门螺杆菌感染可以增加或降低胃酸分泌，这取决于胃内炎症的分布。[2b,B]

Statement 5: On average, H.pylori status has no effect on symptom severity, symptom recurrence and treatment efficacy in GORD. H. pylori eradication does not exacerbate pre-existing GORD or affect treatment efficacy.[1a,A]

平均而言，幽门螺杆菌状态对胃食管反流病（GERD）症状的严重性、症状复发和治疗效果无影响。根除幽门螺杆菌不会加重原本已存在的GERD，不会影响治疗效果。[1a,A]

Statement 6: Epidemiological studies show a negative association between the prevalence of H.pylori and the severity of GORD and incidence of esophageal adenocarcinoma.[2a,B]

流行病学研究表明，幽门螺杆菌感染率与GERD严重性和食道腺癌发病率呈负相关。[2a,B]

Statement 7: H. pylori infection is associated with an increased risk of uncomplicated and complicated gastroduodenal ulcers in NSAID and low-dose aspirin (acetosalicylic acid (ASA)) users. [2a,B] Eradication reduces the risk of complicated and uncomplicated gastroduodenal ulcers associated with either NSAID or low-dose ASA use.[1b,A]

幽门螺杆菌感染与服用非甾体类抗炎药（NSAID）和低剂量阿司匹林者发生胃十二指肠溃疡（无或有并发症）的风险增加相关。[2a,B] 根除幽门螺杆菌可降低服用NSAID或低剂量阿司匹林者发生胃十二指肠溃疡（无或有并发症）的风险。[1b,A]

Statement 8: H. pylori eradication is beneficial before starting NSAID treatment. It is mandatory in patients with a peptic ulcer history [1b,A]. However, H pylori eradication alone does not reduce the incidence of gastroduodenal ulcers in patients already receiving long-term NSAID treatment. They require continued PPI treatment as well as eradication treatment.[1b,A]

在NSAID治疗开始前根除幽门螺杆菌是有益的。有消化性溃疡病史者必须进行根除。然而单单根除幽门螺杆菌不能降低已在接受长期NSAID治疗患者胃十二指肠溃疡的发生率。他们除需要根除幽门螺杆菌外，还要持续质子泵抑制剂（PPI）治疗。[1b,A]

Statement 9: Testing for H. pylori should be performed in ASA users with a history of gastroduodenal ulcer. The long-term incidence of peptic ulcer bleeding is low in