WHO - WHEN TO TREAT - GASTRITIS, PARTICULAR HISTOLOGICAL LESIONS, NSAID THERAPY AND EXTRADIGESTIVE DISEASES

Indications of whom and when to treat Helicobacter pylon infection are reviewed in chronic atrophic gastritis, in particular types of gastri tis (lymphocytic, giant fold, auto-immune gastritis), in hyperplastic polyps, before or during treatment with NSAIDs and in association with various extra-digestive diseases. Although there is no convincing evi dence that Helicobacter pylori eradication may interrupt or reverse mu cosal atrophy and intestinal metaplasia (potentially pre-cancerous les ions), indication for eradication could be considered in young patient s if atrophic gastritis is considered as a consequence of chronic supe rficial gastritis which is reversible after Helicobacter pylori cure, The still evidence limited for a causal relationship between Helicobac ter pylori and lymphocytic gastritis, giant folds gastritis and hyperp lastic polyps suggests it is acceptable to eradicate Helicobacter pylo ri in infected patients presenting these special forms of gastritis, D espite the uncertainty on the interactions of Helicobacter pylori and NSAID in the genesis of peptic ulcer disease, it seems acceptable to p rescribe eradication treatment in known Helicobacter pylori carriers b efore a long-term treatment with NSAID. The clinical evidence for an a ssociation between Helicobacter pylori and extra-digestive diseases is at the present time too limited to advocate routine eradication in th ese conditions before large prospective trials are performed.