Consensus guidelines: Agreement and debate surrounding the optimal management of Helicobacter pylori infection

Helicobacter pylori is a recognized cause of a variety of gastroduodenal pa thology. The high prevalence of both H pylori infection and related disease s within the community warrants its consideration as a public health care i ssue. The availability of reliable and safe noninvasive diagnostic techniqu es coupled with the development of effective and tolerable treatments has e nabled primary health care personnel to manage this infection actively. The role of the primary care physician in the future management of H pylori in fection is thus of central importance. The wealth of evidence produced by o ver 15 years of research into H pylori has expanded the list of disease ass ociations and treatment benefits as well as elucidated the pathophysiologic al mechanisms involved. As a result, there has been a growing need to harmo nize this information with clinical practice and to provide direction for t he appropriate management by both specialists and general practitioners. Se veral national guidelines have been produced. The areas relating to H pylor i infection that they considered and their recommendations vary. In 1994, t he National Institutes of Health produced globally accepted recommendations for the management of H pylori-related peptic ulceration. The broader role of H pylori as a gastroduodenal pathogen and a public health care issue wa s not addressed. Recently, European and Canadian consensus guidelines have been published that identified overall management issues, including the rol e of primary and specialist care, and considered the appropriateness of emp loying eradication therapy for the spectrum of conditions in which H pylori has a direct or indirect association based on the available information. T hese guidelines, while in agreement regarding many issues, differ considera bly in their recommendations for primary health care and regarding central issues such as the management of dyspepsia and gastric cancer. Some variati ons may reflect differing health care structures as well as the prevalence of both infection and associated diseases. However, the interpretation of e vidence produced by recent research contributes to their conflicting statem ents.