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1 Maastricht Ⅴ /Florence Maastricht V 1 / / 5 Maastricht Ⅴ Interpretation of Management of Helicobacter pylori Infection the Maastricht Ⅴ / Florence Consensus Report LIU Wenzhong. Division of Gastroenterology and Hepatology Ren Ji Hospital School of Medicine Shanghai Jiao Tong University Shanghai Institute of Digestive Disease Shanghai Abstract Management of Helicobacter pylori infection the Maastricht Ⅴ Consensus Conference held in Florence Italy October 8-9th 2015 was convened for developing a new consensus on the management of Helicobacter pylori infection in following aspects 1. Indication /Associations 2. Diagnosis 3. Treatment 4. Prevention /Public Health 5. Helicobacter pylori and the Gastric Microbiota. A detailed interpretation of these contents was made in this paper. Key words Helicobacter pylori Maastricht Ⅴ Consensus Report Diagnosis Therapy Dyspepsia Stomach Neoplasms Preventive Medicine Gastric Microbiota Hp Hp Delphi 5 / - / Hp 70 5 Hp Maastricht DOI /j. issn b A 3 Hp Hp 4 Hp 2 5 Hp Gut Online First published Hp 10% on October / Hp 1 Hp 7 Hp

2 578 Chin J Gastroenterol 2016 Vol. 21 No % 9 PPI Hp Hp Hp PPI Hp Hp PPI 10 Hp Ⅳ 5 Hp B12 Hp 11 Hp Hp MALT Hp 1. Hp 1 Hp 2 Hp 3. Hp 4 - Hp Hp 2. Hp Hp Hp Hp Hp 8 - Hp < 20% Hp Hp Hp Hp Ⅳ 5 3Hp Hp Hp 2005 / 6 Hp 2 Hp < 20% Hp - Koch Hp Hp Hp Hp 5. Hp meta 1

3 Hp 2a B 2 PPI 2 4 2b B Hp 1 Giemsa 2b Hp B 4 Hp MALT 2 3 cm b B 5 Hp Hp Hp PG Hp 2b A 6 1 Hp < 15% 2 > 15% 7 3 Hp 8 Hp B 2a PGⅠ /Ⅱ PPI + 2a A 10 Hp 4 1. Hp PPI- 9 PG 4 > 15% d 10 d

4 580 Chin J Gastroenterol 2016 Vol. 21 No PPI d 10 d PPI PPI 2 PPI Hp Hp 11 PPI- PPI + + PPI d PPI + + Hp Hp 20% ~ 40% > 60% 13 PPI Hp 14 d 10 d d > 90% Hp Hp Hp d 7 d PPI + 5 d 7 d PPI + + PPI + + +

5 d 14 d 5 d 7 d 5 d 7 d 10 > 15% PPI- 15% ~ 35% / 1 Hp ITT > 80% a A 4. Hp PPI Hp 2a A 5 Hp Pylera PPI 1b B Pylera 14 d b A Hp b PPI PPI Hp 17 - > 9 Hp 15% Hp Hp Hp 5. PPI Hp PPI Hp PPI CYP2C19 13 PPI Hp PPI CYP2C19 14 / Hp 2 2c B 3 Hp 6 Hp B

6 582 Chin J Gastroenterol 2016 Vol. 21 No D Hp Hp 29 1b A 17 Hp Hp 30 4 D 1. Hp Hp Hp 2% ~ 3% 23 Hp < 1% 24 Hp Hp 9 Hp 90% / / Hp Hp Hp 1 Hp 2c B WHO % 2 Hp 24. 2% 45% Hp Hp Hp D 3 Hp Hp 4 Hp / 2 2c B / 5 Hp 2c B 6 / Hp 2 23 Hp 2c B / 7 Hp 2c 26 B 8 Hp D 3. Hp Hp Hp Hp Hp 10 Hp

7 Hp Hp meta 33 2 ph 34 Hp 31 Hp ph ph ph 1 ~ 2 6 ~ 7 ph 2. Hp Hp 1 Malfertheiner P Megraud F O Morain CA et al Hp European Helicobacter Study Group. Management of Helicobacter pylori infection -- the Maastricht Ⅳ / Florence Consensus Report J. Gut Hp / 2 Sugano K Tack J Kuipers EJ et al faculty members of Hp Kyoto Global Consensus Conference. Kyoto global consensus report on Helicobacter pylori gastritis J. Gut 1 / Ford AC Qume M Moayyedi P et al. Helicobacter pylori 31 PPI test and treat or endoscopy for managing dyspepsia an 32 Hp 4. Hp 9 10 individual patient data meta-analysis J. Gastroenterology 3. Hp / Hp 2 J Hp Stanghellini V Chan FK Hasler WL et al. Gastroduodenal Hp Disorders J. Gastroenterology Hp 6 Talley NJ Vakil NB Moayyedi P. American gastroenterological association technical review on the evaluation of dyspepsia Hp 6 J. Gastroenterology J Hp 8 Malfertheiner P. The intriguing relationship of Helicobacter pylori infection and acid secretion in peptic ulcer disease and gastric cancer J. Dig Dis Hp Hp 9 Graham DY. Helicobacter pylori update gastric cancer reliable therapy and possible benefits J. Gastroenterology Graham DY Dore MP. Helicobacter pylori therapy a

8 584 Chin J Gastroenterol 2016 Vol. 21 No. 10 paradigm shift J. Expert Rev Anti Infect Ther Zhou L Zhang J Song Z et al. Tailored versus Triple plus Bismuth or Concomitant Therapy as Initial Helicobacter pylori Treatment A Randomized Trial J. Helicobacter Zhang YX Zhou LY Song ZQ et al. Primary antibiotic resistance of Helicobacter pylori strains isolated from patients with dyspeptic symptoms in Beijing a prospective serial study J. World J Gastroenterol Sun Q Liang X Zheng Q et al. High efficacy of 14-day triple therapy-based bismuth-containing quadruple therapy for initial Helicobacter pylori eradication J. Helicobacter Liao J Zheng Q Liang X et al. Effect of fluoroquinolone resistance on 14-day levofloxacin triple and triple plus Cancer Biol Pt B bismuth quadruple therapy J. Helicobacter Asaka M Kato M Sakamoto N. Roadmap to eliminate gastric cancer with Helicobacter pylori eradication and 15 Zhou L Zhang J Chen M et al. A comparative study of consecutive surveillance in Japan J. J Gastroenterol sequential therapy and standard triple therapy for Helicobacter pylori infection a randomized multicenter trial 28 Graham DY. Roadmap for elimination of gastric cancer in J. Am J Gastroenterol Korea J. Korean J Intern Med J Pan KF Zhang L Gerhard M et al. A large randomised 17 Gisbert JP Romano M Gravina AG et al. Helicobacter pylori second-line rescue therapy with levofloxacin- and controlled intervention trial to prevent gastric cancer by eradication of Helicobacter pylori in Linqu County China bismuth-containing quadruple therapy after failure of baseline results and factors affecting the eradication J. standard triple or non-bismuth quadruple treatments J. Aliment Pharmacol Ther Gut Zeng M Mao XH Li JX et al. Efficacy safety and 18 Dore MP Lu H Graham DY. Role of bismuth in immunogenicity of an oral recombinant Helicobacter pylori improving Helicobacter pylori eradication with triple therapy vaccine in children in China a randomised double-blind J. Gut Ford AC Malfertheiner P Giguere M et al. Adverse events with bismuth salts for Helicobacter pylori eradication systematic review and meta-analysis J. World J Gastroenterol McNicholl AG Linares PM Nyssen OP et al. Metaanalysis esomeprazole or rabeprazole vs. first-generation pump inhibitors in the treatment of Helicobacter pylori infection J. Aliment Pharmacol Ther Ford AC Forman D Hunt RH et al. Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals systematic review and meta-analysis of randomised controlled trials J. BMJ g Lee YC Chiang TH Chou CK et al. Association Between Helicobacter pylori Eradication and Gastric Cancer Incidence A Systematic Review and Meta-analysis J. Gastroenterology Sugano K. Strategies for Prevention of Gastric Cancer Progress from Mass Eradication Trials J. Dig Dis Matsuo T Ito M Takata S et al. Low prevalence of Helicobacter pylori-negative gastric cancer among Japanese J. Helicobacter Plummer M de Martel C Vignat J et al. Global burden of cancers attributable to infections in 2012 a synthetic analysis J. Lancet Glob Health e609-e Shiotani A Cen P Graham DY. Eradication of gastric cancer is now both possible and practical J. Semin placebo-controlled phase 3 trial J. Lancet Hunt RH Camilleri M Crowe SE et al. The stomach in health and disease J. Gut Jackson MA Goodrich JK Maxan ME et al. Proton pump inhibitors alter the composition of the gut microbiota J. Gut Lu C Sang J He H et al. Probiotic supplementation does not improve eradication rate of Helicobacter pylori infection compared to placebo based on standard therapy a metaanalysis J. Sci Rep Fallone CA Chiba N van Zanten SV et al. The Toronto Consensus for the Treatment of Helicobacter pylori Infection in Adults J. Gastroenterology

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