Table 7.2-4. Indications for treatment of Helicobacter pylori infection, where present, according to the Maastricht IV/Florence Consensus Conference

1. Gastric and/or duodenal ulcer (active or healed, as well as complications of ulcer disease)

2. Gastric MALT lymphoma

3. First-degree relatives of patients with gastric cancer

4. Prior endoscopic or subtotal gastric resection in the treatment of gastric neoplasia (MALT lymphoma, gastric adenoma, gastric cancer)

5. Severe pangastritis, corpus-predominant gastritis, or severe atrophy

6. Chronic gastric acid inhibition for >1 year

7. Strong environmental risk factors for gastric cancer (heavy smoking, high exposure to dust, coal, quartz, cement, and/or work in quarries)

8. At the patient’s request in case of fear of gastric cancer

9. Dyspepsia not associated with peptic ulcer

10. Undiagnosed dyspepsia (test-and-treat strategy)a

11. Prevention of development of ulcers and their complications before or during a long-term NSAID treatmentb

12. Unexplained iron deficiency anemia

13. Primary immune thrombocytopenic purpura

14. Vitamin B12 deficiency

a In regions with a low prevalence of Helicobacter pylori infection, the effectiveness of this strategy is low and empiric acid inhibition is an equivalent option.

b In patients who are already receiving long-term NSAID treatment, it is recommended to combine eradication with PPI administration.

MALT, mucosa-associated lymphoid tissue; NSAID, nonsteroidal anti-inflammatory drug; PPI, proton pump inhibitor.