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Appropriateness of care – Diagnosis and treatment of Helicobacter pylori infection in adults

Validation date
May 2017

The appropriateness tools « Diagnosis of Helicobacter pylori infection in adults » and « Treatment of Helicobacter pylori infection in adults » were produced by the French National Authority for Health (HAS) in partnership with the French National Council of gastroenterologists.
They are intended mainly for gastroenterologists and general practitioners but also for all healthcare professionals involved in diagnosis or treatment of Helicobacter pylori (H. pylori) infected patients.
H. pylori infection is caused by a bacteria that colonizes exclusively the gastric mucosa and which transmission is from human to human. The prevalence of the infection is around 15 to 30 % in France. H. pylori plays a major role in the development of gastroduodenal ulcer and gastric cancer (adenocarcinoma and MALT lymphoma). Treatment of the infection as demonstrated its efficacy in preventing the occurrence of gastric cancer and recurrences of gastric and duodenal ulcer. It leads to a durable remission of low-level MALT gastric lymphoma. However, progression of bacterial resistance to antibiotics, in particular to clarithromycin (22% of strains), means there is a need to adapt diagnostic and therapeutic practices.
Database analysis and practice surveys among gastroenterologists and general practitioners who take of infected patients, have demonstrated some inappropriate practices concerning indications and modalities of H.pylori testing or treatment.
To respond to these issues, two appropriateness tools including short recommendations and algorithms were produced: one for diagnosis, the other one for treatment, intended to help professionals to make decision for diagnosis and treatment of infected patients. Their aims are to improve appropriateness and quality of care and to better prevent gastric cancer, keeping in mind the necessity of preserving bacterial ecology and limiting development of antibiotic resistance, considering the high clarithrithromycin resistance rate in France.

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Posted on Jun 21 2017