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 theintragastric 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 inthese patients after receiving eradication even in the absence of gastroprotective treatment.[2b,B]有胃十二指肠溃疡病史的阿司匹林服用者必须检测幽门螺杆菌。

接受根除治疗后，即使无胃保护治疗，这些患者中消化性溃疡出血的长期发生率低。

[2b,B] Statement 10a: Long-term treatment with PPIs in H.pylori-positive patients is associated with the development of a corpus-predominant gastritis. This accelerates the process of loss of specialised glands, leading to atrophic gastritis.[1c,A] 幽门螺杆菌阳性患者长期PPI治疗与发生胃体为主胃炎相关。

这可加速特殊腺体的丢失，从而导致萎缩性胃炎。

[1c,A]Statement 10b: Eradication of H. pylori in patients receiving long-term PPIs heals gastritis and prevents the progression to atrophic gastritis. However, there is no evidence that this reduces the risk of gastric cancer.[1b,A]接受长期PPI治疗的患者根除幽门螺杆菌可愈合胃炎，预防萎缩性胃炎发生。

但尚无证据表明，这可降低胃癌发生的风险。

[1b,A]Statement 11a: There is accumulating evidence that after H.pylori eradication, corpus function may improve. However, whether this is associated with regression of atrophic gastritis remains equivocal.[2a,B]越来越多的证据表明，幽门螺杆菌根除后，胃体功能改善。

然而，这一相关性是否由于萎缩性胃炎逆转尚不明确。

[2a,B]Statement 11b: There is no evidence that H. pylori eradication can lead to regression of intestinal metaplasia.[2a,B]尚无证据表明，根除幽门螺杆菌能逆转肠化生。

[2a,B]Statement 12: H. pylori eradication is the first-line treatment for low-grade gastric marginal zone (MALT) lymphoma.[1a,A]根除幽门螺杆菌是低级别胃MALT淋巴瘤的一线治疗。

[1a,A]Statement 13: There is evidence linking H. pylori to the aetiology of otherwise unexplained iron-deficiency anemia, idiopathic thrombocytopenic purpura (ITP) and vitamin B12 deficiency. In these disorders, H pylori should be sought and eradicated.1. Iron-deficiency anaemia[1a,A]2. ITP [1b,A]3. Vitamin B12 deficiency [3b, B]The evidence available shows no unequivocal causative association between H pylori and other extragastric disorders, including cardiovascular and neurological disorders.有证据表明，幽门螺杆菌与不明原因缺铁性贫血、特发性血小板减少性紫癜（ITP）和维生素B12缺乏的发病相关。