Pimanov SI, Makarenko EV. Updated the Maastricht VI/Florence Consensus recommendations for the treatment of Helicobacter pylori infection: A review. Consilium Medicum. 2022;24(12):851–859.
DOI: 10.26442/20751753.2022.12.202045
Обновленные рекомендации Маастрихт VI/Флорентийского консенсуса по лечению инфекции Helicobacter pylori
Пиманов С.И., Макаренко Е.В. Обновленные рекомендации Маастрихт VI/Флорентийского консенсуса по лечению инфекции Helicobacter pylori. Consilium Medicum. 2022;24(12):851–859.
DOI: 10.26442/20751753.2022.12.202045
Pimanov SI, Makarenko EV. Updated the Maastricht VI/Florence Consensus recommendations for the treatment of Helicobacter pylori infection: A review. Consilium Medicum. 2022;24(12):851–859.
DOI: 10.26442/20751753.2022.12.202045
В новом Маастрихт VI/Флорентийском консенсусе уточнен ряд положений, которые раньше находились на стадии обсуждения. Позиционировано, что инфекция Helicobacter pylori всегда вызывает гастрит независимо от симптомов или осложнений. Перед постановкой убедительного диагноза функциональной диспепсии необходимо исключить хеликобактерный гастрит. Некоторые положения консенсуса, например тактика «тестируй и лечи», требуют элементов критического отношения с учетом региональных российских условий. Около 90% случаев рака желудка связано с H. pylori. Эрадикация H. pylori дает возможность предотвратить рак желудка в любом возрасте у взрослых, однако эффективность такой канцерпревенции уменьшается с возрастом. В алгоритме эрадикационной терапии предпочтение отдается квадротерапии с применением препаратов висмута. Снизилось значение тройной терапии с кларитромицином. Отмечается быстрый рост резистентности H. pylori к фторхинолонам. Финишным протоколом эрадикации названа тройная терапия с рифабутином.
Ключевые слова: Helicobacter pylori, ингибиторы протонной помпы, эрадикация, тройная терапия, висмутовая квадротерапия, резистентность к антибиотикам, противомикробные лекарственные средства
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The new Maastricht VI/Florence Consensus clarifies a number of provisions that were previously under discussion. It has been postulated that Helicobacter pylori infection always causes gastritis, regardless of symptoms or complications. Before making a convincing diagnosis of functional dyspepsia, it is necessary to exclude Helicobacter’s gastritis. Some provisions of the consensus, such as the “test and treat” tactic, require elements of a critical attitude, taking into account Russian regional conditions. About 90% of stomach cancers are due to H. pylori. Eradication of H. pylori makes it possible to prevent gastric cancer at any age in adulthood, but the effectiveness of such cancer prevention decreases with age. Bismuth quadruple therapy is preferred in the eradication therapy algorithm. Decreased value of triple treatment with clarithromycin. There is a rapid increase in H. pylori resistance to fluoroquinolones. Triple therapy with rifabutin is called the final eradication protocol.
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2. Malfertheiner P, Megraud F, Rokkas T, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022;71(9):1724-62.
DOI:10.1136/gutjnl-2022-327745
3. Malfertheiner P, Megraud F, O'Morain CA, et al. Management of Helicobacter pylori infection – the Maastricht V/Florence Consensus Report. Gut. 2017;66(1):6-30.
DOI:10.1136/gutjnl-2016-312288
4. Пиманов С.И., Макаренко Е.В. Рекомендации Маастрихт V/Флорентийского консенсуса по лечению хеликобактерной инфекции. Consilium Medicum. 2017;19(8):8-27 [Pimanov SI, Makarenko EV. Recommendations of the Maastricht V/Florence consensus for the Helicobacter pylori treatment. Consilium Medicum. 2017;9(8):8-27 (in Russian)].
5. Sugano K, Tack J, Kuipers EJ, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2015;64(9):1353-67. DOI:10.1136/gutjnl-2015-309252
6. Stanghellini V, Chan FK, Hasler WL, et al. Gastroduodenal Disorders. Gastroenterology. 2016;150(6):1380-92. DOI:10.1053/j.gastro.2016.02.011
7. Wauters L, Dickman R, Drug V, et al. United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on functional dyspepsia. United European Gastroenterol J. 2021;9(3):307-31. DOI:10.1002/ueg2.12061
8. Ивашкин В.Т., Маев И.В., Лапина Т.Л., и др. Клинические рекомендации Российской гастроэнтерологической ассоциации и ассоциации «Эндоскопическое общество РЭНДО» по диагностике и лечению гастрита, дуоденита. Российский журнал гастроэнтерологии, гепатологии и колопроктологии. 2021;31(4):70-9 [Ivashkin VT, Maev IV, Lapina TL, et al. Clinical Recommendations of Russian Gastroenterological Association and RENDO Endoscopic Society on Diagnosis and Treatment of Gastritis and Duodenitis. Russian Journal of Gastroenterology, Hepatology and Coloproctology. 2021;31(4):70-99 (in Russian)]. DOI:10.22416/1382-4376-2021-31-4-70-99
9. Ивашкин В.Т., Маев И.В., Шептулин А.А., и др. Клинические рекомендации Российской гастроэнтерологической ассоциации по диагностике и лечению функциональной диспепсии. Российский журнал гастроэнтерологии, гепатологии и колопроктологии. 2017;27(1):50-61 [Ivashkin VT, Mayev IV, Sheptulin AA, et al. Diagnosis and treatment of the functional dyspepsia: clinical guidelines of the Russian Gastroenterological Association. Russian Journal of Gastroenterology, Hepatology and Coloproctology. 2017;27(1):50-61 (in Russian)]. DOI:10.22416/1382-4376-2017-27-1-50-61
10. Ивашкин В.Т., Маев И.В., Трухманов А.С., и др. Воспаление, нарушение моторной функции и висцеральная гиперчувствительность: основные механизмы функциональных расстройств желудочно-кишечного тракта (обзор литературы и резолюция Совета Экспертов). Российский журнал гастроэнтерологии, гепатологии и колопроктологии. 2022;32(1):7-14 [Ivashkin VT, Maev IV, Trukhmanov AS, et al. Inflammation, impaired motor function and visceral hypersensitivity: the main mechanisms of functional disorders of the gastrointestinal tract (materials of the Expert Council and literature review). Russian Journal of Gastroenterology, Hepatology and Coloproctology. 2022;32(1):7-14 (in Russian)]. DOI:10.22416/1382-4376-2022-32-1-7-14
11. Пиманов С.И., Макаренко Е.В., Воропаева А.В., Матвеенко М.Е. Динамика морфологических и функциональных характеристик слизистой оболочки желудка после эрадикации Helicobacter pylori у больных с язвами двенадцатиперстной кишки. Терапевтический архив. 2006;78(2):26-31 [Pimanov SI, Makarenko EV, Voropaeva AV, Matveenko ME. Time course changes in morphological and functional characteristics of gastric mucosa after eradication of Helicobacter pylori in duodenal ulcers. Terapevticheskii Arkhiv (Ter. Arkh.). 2006;78(2):26-31 (in Russian)].
12. Ungaro R, Bernstein CN, Gearry R, et al. Antibiotics associated with increased risk of new-onset Crohn's disease but not ulcerative colitis: a meta-analysis. Am J Gastroenterol. 2014;109(11):1728-38. DOI:10.1038/ajg.2014.246
13. Milanović V, Osimani A, Cardinali F, et al. Erythromycin-resistant lactic acid bacteria in the healthy gut of vegans, ovo-lacto vegetarians and omnivores. PLoS One. 2019;14(8):e0220549. DOI:10.1371/journal.pone.0220549
14. Zhang M, Zhang C, Zhao J, et al. Meta-analysis of the efficacy of probiotic-supplemented therapy on the eradication of H. pylori and incidence of therapy-associated side effects. Microb Pathog. 2020;147:104403. DOI:10.1016/j.micpath.2020.104403
15. Gisbert JP, McNichol AG. Eradication of Helicobacter pylori infection with non-bismuth quadruple concomitant therapy. In: AU Rahman, MI Choudhary, eds. Frontiers in anti-infective drug discovery Bentham science publishers, 2020; p. 1-34.
16. Nyssen OP, Bordin D, Tepes B, et al. European Registry on Helicobacter pylori management (Hp-EuReg): patterns and trends in first-line empirical eradication prescription and outcomes of 5 years and 21 533 patients. Gut. 2021;70(1):40-54. DOI:10.1136/gutjnl-2020-321372
17. Пиманов С.И., Макаренко Е.В. Оптимизированные эрадикационные протоколы: рекомендации американской коллегии гастроэнтерологов, Маастрихт V/Флорентийского и Торонтского консенсусов. Медицинский Совет. 2017;15:10-7 [Pimanov SI, Makarenko EV. Optimized eradication protocols: recommendations of the american gastroenterologist board, Masstrikht V/fFlorentine and Toronto consensuses. Meditsinskii Sovet. 2017;15:10-7 (in Russian)]. DOI:10.21518/2079-701X-2017-15-10-17
18. Espada M, Nyssen OP, Gisbert JP. Empirical versus susceptibility-guided treatment of Helicobacter pylori infection: a meta-analysis. United European Gastroenterol J. 2020;8:251.
19. Пиманов С.И., Макаренко Е.В., Дикарева Е.А. Соблюдение схемы терапии ингибиторами протонного насоса при постоянном приеме нестероидных противовоспалительных средств. Терапевтический архив. 2015;87(4):58-61 [Pimanov SI, Makarenko EV, Dikareva EA. Adherence with proton pump inhibitor therapy, by continuously taking nonsteroidal antiinflammatory drugs. Terapevticheskii Arkhiv (Ter. Arkh.). 2015;87(4):58-61 (in Russian)]. DOI:10.17116/terarkh201587458-61
20. Андреев Д.Н., Маев И.В., Кучерявый Ю.А. Резистентность Helicobacter pylori в Российской Федерации: метаанализ исследований за последние 10 лет. Терапевтический архив. 2020;92(11):24-30 [Andreev DN, Maev IV, Kucheryavyy YA Helicobacter pylori resistance in the Russian Federation: a meta-analysis of studies over the past 10 years. Terapevticheskii Arkhiv (Ter. Arkh.). 2020;92(11):24-30 (in Russian)]. DOI:10.26442/00403660.2020.11.000795
21. Дехнич Н.Н., Иванчик Н.В., Козлов Р.С., и др. Антибиотикорезистентность Helicobacter pylori в Смоленске. Клиническая микробиология и антимикробная химиотерапия. 2018;20(1):42-8 [Dehnich NN, Ivanchik NV, Kozlov RS, et al. Antibiotic resistance of Helicobacter pylori in Smolensk. Clinical Microbiology and Antimicrobial Chemotherapy. 2018;20(1):42-8 (in Russian)]. DOI:10.36488/cmac.2018.1.42-48
22. Mégraud F, Graham DY, Howden CW, et al. Rates of Antimicrobial Resistance in Helicobacter pylori Isolates from Clinical Trial Patients Across the US and Europe. Am J Gastroenterol. 2022. DOI:10.14309/ajg.0000000000002045.
23. Hulten KG, Lamberth LB, Kalfus IN, Graham DY. National and Regional US Antibiotic Resistance to Helicobacter pylori: Lessons From a Clinical Trial. Gastroenterology. 2021;161(1):342-4.e1. DOI:10.1053/j.gastro.2021.03.045.
24. Пиманов С.И., Попов С.А., Макаренко Е.В. Мета-анализ эффективности эрадикационной терапии Helicobacter pylori по протоколу «омепразол-кларитромицин-амоксициллин». Consilium Medicum. Гастроэнтерология. 2003;2:11-3 [Pimanov SI, Popov SA, Makarenko EV. Meta-analysis of the effectiveness of Helicobacter pylori eradication therapy according to the protocol “omeprazole-clarithromycin-amoxicillin”. Consilium Medicum. Gastroenterology. 2003;2:11-3 (in Russian)].
25. Fernández-Salazar L, Campillo A, Rodrigo L, et al. Effectiveness and Safety of High-Dose Dual Therapy: Results of the European Registry on the Management of Helicobacter pylori Infection (Hp-EuReg). J Clin Med. 2022;11(12):3544. DOI:10.3390/jcm11123544
26. Liang X, Xu X, Zheng Q, et al. Efficacy of bismuth-containing quadruple therapies for clarithromycin-, metronidazole-, and fluoroquinolone-resistant Helicobacter pylori infections in a prospective study. Clin Gastroenterol Hepatol. 2013;11(7):802-7.e1. DOI:10.1016/j.cgh.2013.01.008
27. Ciccaglione AF, Tavani R, Grossi L, et al. Rifabutin Containing Triple Therapy and Rifabutin with Bismuth Containing Quadruple Therapy for Third-Line Treatment of Helicobacter pylori Infection: Two Pilot Studies. Helicobacter. 2016;21(5):375-81. DOI:10.1111/hel.12296
28. Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108(3):308-28. DOI:10.1038/ajg.2012.444
29. Ericsson CD, Feldman S, Pickering LK, Cleary TG. Influence of subsalicylate bismuth on absorption of doxycycline. JAMA. 1982;247(16):2266-7.
________________________________________________
1. Ivashkin VT, Mayev IV, Lapina TL, et al. Diagnostics and treatment of Helicobacter pylori infection in adults: Clinical guidelines of the Russian gastroenterological association. Russian Journal of Gastroenterology, Hepatology and Coloproctology. 2018;28(1):55-70 (in Russian). DOI:10.22416/1382-4376-2018-28-1-55-70
2. Malfertheiner P, Megraud F, Rokkas T, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022;71(9):1724-62.
DOI:10.1136/gutjnl-2022-327745
3. Malfertheiner P, Megraud F, O'Morain CA, et al. Management of Helicobacter pylori infection – the Maastricht V/Florence Consensus Report. Gut. 2017;66(1):6-30.
DOI:10.1136/gutjnl-2016-312288
4. Pimanov SI, Makarenko EV. Recommendations of the Maastricht V/Florence consensus for the Helicobacter pylori treatment. Consilium Medicum. 2017;9(8):8-27 (in Russian).
5. Sugano K, Tack J, Kuipers EJ, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2015;64(9):1353-67. DOI:10.1136/gutjnl-2015-309252
6. Stanghellini V, Chan FK, Hasler WL, et al. Gastroduodenal Disorders. Gastroenterology. 2016;150(6):1380-92. DOI:10.1053/j.gastro.2016.02.011
7. Wauters L, Dickman R, Drug V, et al. United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on functional dyspepsia. United European Gastroenterol J. 2021;9(3):307-31. DOI:10.1002/ueg2.12061
8. Ivashkin VT, Maev IV, Lapina TL, et al. Clinical Recommendations of Russian Gastroenterological Association and RENDO Endoscopic Society on Diagnosis and Treatment of Gastritis and Duodenitis. Russian Journal of Gastroenterology, Hepatology and Coloproctology. 2021;31(4):70-99 (in Russian). DOI:10.22416/1382-4376-2021-31-4-70-99
9. Ivashkin VT, Mayev IV, Sheptulin AA, et al. Diagnosis and treatment of the functional dyspepsia: clinical guidelines of the Russian Gastroenterological Association. Russian Journal of Gastroenterology, Hepatology and Coloproctology. 2017;27(1):50-61 (in Russian). DOI:10.22416/1382-4376-2017-27-1-50-61
10. Ivashkin VT, Maev IV, Trukhmanov AS, et al. Inflammation, impaired motor function and visceral hypersensitivity: the main mechanisms of functional disorders of the gastrointestinal tract (materials of the Expert Council and literature review). Russian Journal of Gastroenterology, Hepatology and Coloproctology. 2022;32(1):7-14 (in Russian).
DOI:10.22416/1382-4376-2022-32-1-7-14
11. Pimanov SI, Makarenko EV, Voropaeva AV, Matveenko ME. Time course changes in morphological and functional characteristics of gastric mucosa after eradication of Helicobacter pylori in duodenal ulcers. Terapevticheskii Arkhiv (Ter. Arkh.). 2006;78(2):26-31 (in Russian).
12. Ungaro R, Bernstein CN, Gearry R, et al. Antibiotics associated with increased risk of new-onset Crohn's disease but not ulcerative colitis: a meta-analysis. Am J Gastroenterol. 2014;109(11):1728-38. DOI:10.1038/ajg.2014.246
13. Milanović V, Osimani A, Cardinali F, et al. Erythromycin-resistant lactic acid bacteria in the healthy gut of vegans, ovo-lacto vegetarians and omnivores. PLoS One. 2019;14(8):e0220549. DOI:10.1371/journal.pone.0220549
14. Zhang M, Zhang C, Zhao J, et al. Meta-analysis of the efficacy of probiotic-supplemented therapy on the eradication of H. pylori and incidence of therapy-associated side effects. Microb Pathog. 2020;147:104403. DOI:10.1016/j.micpath.2020.104403
15. Gisbert JP, McNichol AG. Eradication of Helicobacter pylori infection with non-bismuth quadruple concomitant therapy. In: AU Rahman, MI Choudhary, eds. Frontiers in anti-infective drug discovery Bentham science publishers, 2020; p. 1-34.
16. Nyssen OP, Bordin D, Tepes B, et al. European Registry on Helicobacter pylori management (Hp-EuReg): patterns and trends in first-line empirical eradication prescription and outcomes of 5 years and 21 533 patients. Gut. 2021;70(1):40-54. DOI:10.1136/gutjnl-2020-321372
17. Pimanov SI, Makarenko EV. Optimized eradication protocols: recommendations of the american gastroenterologist board, Masstrikht V/fFlorentine and Toronto consensuses. Meditsinskii Sovet. 2017;15:10-7 (in Russian). DOI:10.21518/2079-701X-2017-15-10-17
18. Espada M, Nyssen OP, Gisbert JP. Empirical versus susceptibility-guided treatment of Helicobacter pylori infection: a meta-analysis. United European Gastroenterol J. 2020;8:251.
19. Pimanov SI, Makarenko EV, Dikareva EA. Adherence with proton pump inhibitor therapy, by continuously taking nonsteroidal antiinflammatory drugs. Terapevticheskii Arkhiv (Ter. Arkh.). 2015;87(4):58-61 (in Russian). DOI:10.17116/terarkh201587458-61
20. Andreev DN, Maev IV, Kucheryavyy YA Helicobacter pylori resistance in the Russian Federation: a meta-analysis of studies over the past 10 years. Terapevticheskii Arkhiv (Ter. Arkh.). 2020;92(11):24-30 (in Russian). DOI:10.26442/00403660.2020.11.000795
21. Dehnich NN, Ivanchik NV, Kozlov RS, et al. Antibiotic resistance of Helicobacter pylori in Smolensk. Clinical Microbiology and Antimicrobial Chemotherapy. 2018;20(1):42-8 (in Russian). DOI:10.36488/cmac.2018.1.42-48
22. Mégraud F, Graham DY, Howden CW, et al. Rates of Antimicrobial Resistance in Helicobacter pylori Isolates from Clinical Trial Patients Across the US and Europe. Am J Gastroenterol. 2022. DOI:10.14309/ajg.0000000000002045.
23. Hulten KG, Lamberth LB, Kalfus IN, Graham DY. National and Regional US Antibiotic Resistance to Helicobacter pylori: Lessons From a Clinical Trial. Gastroenterology. 2021;161(1):342-4.e1. DOI:10.1053/j.gastro.2021.03.045.
24. Pimanov SI, Popov SA, Makarenko EV. Meta-analysis of the effectiveness of Helicobacter pylori eradication therapy according to the protocol “omeprazole-clarithromycin-amoxicillin”. Consilium Medicum. Gastroenterology. 2003;2:11-3 (in Russian).
25. Fernández-Salazar L, Campillo A, Rodrigo L, et al. Effectiveness and Safety of High-Dose Dual Therapy: Results of the European Registry on the Management of Helicobacter pylori Infection (Hp-EuReg). J Clin Med. 2022;11(12):3544. DOI:10.3390/jcm11123544
26. Liang X, Xu X, Zheng Q, et al. Efficacy of bismuth-containing quadruple therapies for clarithromycin-, metronidazole-, and fluoroquinolone-resistant Helicobacter pylori infections in a prospective study. Clin Gastroenterol Hepatol. 2013;11(7):802-7.e1. DOI:10.1016/j.cgh.2013.01.008
27. Ciccaglione AF, Tavani R, Grossi L, et al. Rifabutin Containing Triple Therapy and Rifabutin with Bismuth Containing Quadruple Therapy for Third-Line Treatment of Helicobacter pylori Infection: Two Pilot Studies. Helicobacter. 2016;21(5):375-81. DOI:10.1111/hel.12296
28. Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108(3):308-28. DOI:10.1038/ajg.2012.444
29. Ericsson CD, Feldman S, Pickering LK, Cleary TG. Influence of subsalicylate bismuth on absorption of doxycycline. JAMA. 1982;247(16):2266-7.
Авторы
С.И. Пиманов*, Е.В. Макаренко
УО «Витебский государственный ордена Дружбы народов медицинский университет», Витебск, Беларусь
*pimanovs@tut.by
________________________________________________
Sergei I. Pimanov*, Elena V. Makarenko
Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Belarus
*pimanovs@tut.by