THE 1998 NATIONAL BELGIAN CONSENSUS MEETING ON HP-RELATED DISEASES - AN EXTENSIVE SUMMARY

''HP testing must be regarded as ONE of the important elements of the proper diagnostic work-up of a DISEASE, managed in dose cooperation be tween GP's and specialists'': that's the key message of the national c onsensus meeting held in CHU Brugmann on February 6(th) and 7(th) 1998 . HP testing (usually by 2 direct methods: RUT-histology) and eradicat ion treatment (ER), in infected patients, are strongly recommended in: 1. Past or current GDU (absolute indication), regardless of activity, complication(s), NSAID intake; 2. Low-grade MALT Lymphomas (Stage IE1 ) unequivocally diagnosed, managed and followed-up in specialised cent ers; 3. Post endoscopic resection of EGG. ER is advisable in HP carrie rs with a family history of gastric cancer. Chronic atrophic-, lymphoc ytic, giant folds gastritis and hyperplastic polyps are acceptable ind ications for ER as well as scheduled long-term NSAID treatment in indi viduals with known HP status. Systematic ER in HP+ patients with fully investigated NUD is not indicated but could be considered in individu al patients. Extra alimentary disorders and auto immune gastritis are no indication and there was no consensus for a ''test and treat'' poli cy in patients under 45 yrs old without alarm symptoms. Systematic scr eening of asymptomatic individuals is not recommended. A correct monit oring of eradication after treatment is recommended, mainly by UBT. In severe or refractory PUD, symptom recurrence and follow-up of EGC and Maltomas, endoscopic follow-up with HP testing is mandatory. The reco mmended first line treatment course (except known allergy or intoleran ce) is PPI full dose bid, Clarithromycin 500 mg bid Amoxycillin 1000 m g bid (7 days minimal 10 days maximal). RBC-based schemes must be loca lly validated and quadruple therapy is proposed when retreatment is ne eded. Culture, optional after the first treatment failure, is strongly recommended after a second failure. Overall, ER therapies are safe an d neither the decreased efficacy of acid-lowering drugs, nor the possi ble increased risk of peptic oesophagitis are considered as contra-ind ications to eradicate. ER is cost-effective and cost-beneficial in PUD and adjusted number of pills delivered would cut costs. No clear econ omic data are currently available for a potential benefit of ER in GC prevention or NUD management. A national monitoring of HP resistance ( Macrolides and Imidazoles) must be organized by specialised centers.