Pellicano R, Fagoonee S, Palestro G, Rizzetto M, Figura N, Ponzetto A
SCDU Gastro-Epatologia, Azienda Ospedaliera S. Giovanni Battista, Turin.
Minerva Gastroenterol Dietol. 2004 Jun;50(2):125-33.
The European Helicobacter pylori Study Group (EHPSG), during the Maastricht 2-2000 Workshop, revised and updated the original guidelines on the management of Helicobacter pylori (H. pylori) infection. The present review focuses on the diagnostic approach for patients referred to the primary care as well as to the specialist. Currently, two diagnostic methods can be used to detect H. pylori: invasive (urease test, histological detection, culture, polymerase chain reaction, smear examination, string test) or non-invasive (serology, urea breath test, antigen stool assay, ''doctor's tests'') tests. These methods vary in their sensitivity and specificity, and the choice depends on the situation, for example, whether the aim is to detect infection or the success of eradication treatment. Urea breath test (UBT) and antigen stool assay are recommended from EHPSG in patients without alarm symptoms or under 45 years of age, at low risk of malignancy in the ''test and treat strategy''. Confirmation of H. pylori eradication following treatment should be tested by UBT; a stool antigen assay is the alternative if the former is not available. Important added value can be gained from other tests: histology allows evaluation of the status of the mucosa while culture allows strain typing and tests for antibiotic susceptibility.
欧洲幽门螺杆菌研究小组（EHPSG）在2000年马斯特里赫特第二次研讨会上，对幽门螺杆菌（H. pylori）感染管理的原始指南进行了修订和更新。本综述重点关注转诊至初级保健机构以及专科医生处的患者的诊断方法。目前，有两种诊断方法可用于检测幽门螺杆菌：侵入性方法（尿素酶试验、组织学检测、培养、聚合酶链反应、涂片检查、串珠试验）或非侵入性方法（血清学、尿素呼气试验、粪便抗原检测、“医生检测”）。这些方法在敏感性和特异性方面各不相同，选择取决于具体情况，例如，目的是检测感染还是根除治疗的成功率。对于无报警症状或年龄在45岁以下、“检测和治疗策略”中恶性肿瘤风险较低的患者，EHPSG推荐使用尿素呼气试验（UBT）和粪便抗原检测。治疗后幽门螺杆菌根除的确认应通过UBT进行检测；如果无法进行前者检测，粪便抗原检测是替代方法。其他检测可提供重要的附加价值：组织学可评估黏膜状态，而培养可进行菌株分型和抗生素敏感性检测。
