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The ACG’s 2007 treatment guideline on the management of H. pylori infection (26) listed the following as established indications for diagnosis and treatment:
===Indications===
*Active PUD (gastric or duodenal).
*Confirmed history of PUD (not previously treated for H. pylori)
*Gastric MALT lymphoma (low grade)
*After endoscopic resection of EGC


Common causes[edit | edit source]<ref name="pmid19683340">{{cite journal| author=Malfertheiner P, Chan FK, McColl KE| title=Peptic ulcer disease. | journal=Lancet | year= 2009 | volume= 374 | issue= 9699 | pages= 1449-61 | pmid=19683340 | doi=10.1016/S0140-6736(09)60938-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19683340  }} </ref>
Recommended  first-line treatment for Helicobacter pylori
*Helicobacter pylori(60% gastric and 50-75% duodenal ulcers ).
*Drugs-NSAIDs including aspirin{<ref name="pmid11960062">{{cite journal |vauthors=Hirschowitz BI, Lanas A |title=Atypical and aggressive upper gastrointestinal ulceration associated with aspirin abuse |journal=J. Clin. Gastroenterol. |volume=34 |issue=5 |pages=523–8 |year=2002 |pmid=11960062 |doi= |url=}}</ref>
Less common causes of peptic ulcer disease
*Hormonal or mediator-induced including secondary acid hypersecretory states
**Gastrinomas
** systemic mastocytosis
** carcinoid syndrome
** myeloproliferative disorder 
**antral g - cell hyperfunction.
*Post-surgical -Antral exclusion and post gastric bypass surgery.
*Tumors-cancers and lymphoma
*Cameron ulcer (gastric ulcer where a hiatus hernia passes
through the diaphragmatic hiatus)
*True idiopathic ulcer.
'''Rare causes of peptic ulcer disease''' <ref name="pmid19683340">{{cite journal| author=Malfertheiner P, Chan FK, McColl KE| title=Peptic ulcer disease. | journal=Lancet | year= 2009 | volume= 374 | issue= 9699 | pages= 1449-61 | pmid=19683340 | doi=10.1016/S0140-6736(09)60938-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19683340  }} </ref>
* Crohn’s disease of the stomach or duodenum
* Eosinophilic gastroduodenitis
* Systemic mastocytosis
* Radiation damage
* Viral infections (eg, cytomegalovirus or herpes simplex
infection, in particular in immunocompromised
patients)
*Colonisation of stomach with H heilmanii
* Severe systemic disease


{| class="wikitable"
!Regimen
!Drug dose
!Dosing frequency
!Duration(days)
!FDA approval
|-
|Clarithromycin triple
|PPI(standard or double dose
Clarithromycin(500mg)


'''Genetic causes''' -<ref name="pmid17312377">{{cite journal| author=Jensen RT, Niederle B, Mitry E, Ramage JK, Steinmuller T, Lewington V et al.| title=Gastrinoma (duodenal and pancreatic). | journal=Neuroendocrinology | year= 2006 | volume= 84 | issue= 3 | pages= 173-82 | pmid=17312377 | doi=10.1159/000098009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17312377  }} </ref>
Amoxicillin(1gm)or Metronidazole(500mg TID)
*Peptic ulcer disease is caused by gastrinomas (Zollinger-Ellison syndrome)caused by a mutation in MEN gene present on chromosome 11q13.
|BID
Causes by organ system[edit | edit source]
|14 days
To obtain the coding for the table seen below, click here. You need to copy the table content from the edit box, and paste it into the edit box.
|YES<sup></sup>
You can then list the causes by organ system. List the causes, separated by a comma under the appropriate category where it says "No underlying causes". Erase "No underlying causes" if you are listing causes in that category.
|-
For an example of the causes by organ system table in a causes microchapter, click here.
|Bismuth Quadruple
Cardiovascular No underlying causes
|PPI(standard dose)
Chemical/Poisoning No underlying causes
Bismuth subcitrate (120-300mg)or Subsalicylate (300mg)
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect -<ref name="pmid17312377">{{cite journal| author=Jensen RT, Niederle B, Mitry E, Ramage JK, Steinmuller T, Lewington V et al.| title=Gastrinoma (duodenal and pancreatic). | journal=Neuroendocrinology | year= 2006 | volume= 84 | issue= 3 | pages= 173-82 | pmid=17312377 | doi=10.1159/000098009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17312377  }} </ref>
*Peptic ulcer disease is caused by gastrinomas (Zollinger-Ellison syndrome)caused by a mutation in MEN gene present on chromosome 11q13.
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental <ref name="pmid28834889">{{cite journal| author=Lee YB, Yu J, Choi HH, Jeon BS, Kim HK, Kim SW et al.| title=The association between peptic ulcer diseases and mental health problems: A population-based study: a STROBE compliant article. | journal=Medicine (Baltimore) | year= 2017 | volume= 96 | issue= 34 | pages= e7828 | pmid=28834889 | doi=10.1097/MD.0000000000007828 | pmc=5572011 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28834889  }} </ref>-smoking, excess alcohol consumption, caffeine intake ,more common in patients with Diabetes Mellitus ,hypertension ,metabolic syndrome
Gastroenterologic-Crohn's disease, Eosinophilic gastroduodenitis.
Genetic --<ref name="pmid17312377">{{cite journal| author=Jensen RT, Niederle B, Mitry E, Ramage JK, Steinmuller T, Lewington V et al.| title=Gastrinoma (duodenal and pancreatic). | journal=Neuroendocrinology | year= 2006 | volume= 84 | issue= 3 | pages= 173-82 | pmid=17312377 | doi=10.1159/000098009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17312377  }} </ref>
*Peptic ulcer disease is caused by gastrinomas (Zollinger-Ellison syndrome)caused by a mutation in MEN gene present on chromosome 11q13.
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease Bacteria: Helicobacter pylori (60% gastric and 50-75% duodenal ulcers ), Viruses:cytomegalovirus,herpes simplex type 1.
Musculoskeletal/Orthopedic No underlying cause
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic non-beta cell tumor, carcinoid syndrome, gastrinomas
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric severe stress, depressed mood, suicidal ideation and psychological counseling
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes
Causes in alphabetical order[edit | edit source]
List the causes of the disease in alphabetical order.


Cause 1
Tetracyclin(500mg)
Cause 2
 
Cause 3
Metronidazole(250-500mg)
Cause 4
|BID
Cause 5
QID
Cause 6
 
Cause 7
QID
Cause 8
 
Cause 9
TID to QID (500mg)
Cause 10
|10-14 days
|NO<sup>‡</sup>
|-
|Concomitant
|PPI (standard dose)
Clarithromycin (500mg)
 
Amoxicillin(1gm)
 
Nitroimidazole(500mg)
|BID
|10 -14 days
|NO
|-
|Sequential
|PPI(standard dose)+Amoxicillin(1gm)
PPI,Clarithromycin(500mg)+Nitroimidazole(500mg)
|BID
 
BID
|5-7 days
 
5-7 days
|NO
|-
|Hybrid
|PPI(standard)+Amoxicillin(1gm)
PPI,Amoxicillin,Clarithromycin(500mg),Nitroimidazole(500mg)
|BID
BID
|7 days
7 days
|NO
|-
|Levofloxacin triple
|PPI(standard dose)
Levofloxacin(500mg)
 
Amoxicillin(1gm)
|BID
QID
 
BID
 
|10-14 days
|NO
|-
|Levofloxacin sequential
|PPI(standard or double dose)+Amoxicillin(1 gm)
PPI,Amoxicillin,Levofloxacin(500mg QD),Nitroimidazole(500mg)
|BID
BID
|5-7 days
|NO
|-
|LOAD
|Levofloxacin(250mg)
PPI(double dose)
 
Nitazoxanide(500mg)
 
Doxycycline(100mg)
|QD
QD
 
BID
 
QD
|7-10 days
|NO
|}
 
'''†''': Several PPI, Clarithromycin, and Amoxicillin combinations have achieved FDA approval ,PPI, Clarithromycin, Metronidazole is not an FDA approved treatment regimen.
 
'''‡:''' PPI, Bismuth, Tetracycline and metronidazole prescribed separately is not an FDA approved treatment regimen.However ,Pylera, a combination product containing Bismuth subcitrate,Tetracycline , Metronidazole combination with PPi for 10 days is an FDA approved regimen.
 
'''Adjuvant therapy in the treatment of H. pylori infection:'''
 
Emerging evidence suggests an inhibitory effect of Lactobacillus
and Bifidobacterium species on H. pylori. Furthermore,
these probiotic strains may also help to reduce the side effects
of eradication therapies and improve compliance with therapy.
 
== Selection of firstline Treatment==
 
{{familytree/start}}
{{familytree |boxstyle=text-align: left; | | | | | | | | | A01 | | | |A01=•Is there a penicillin (PCN) allergy?<br> •Previous macrolide (MCL) exposure for any reason ?<br>}}
{{familytree | | |,|-|-|-|-|v|-|^|-|v|-|-|-|.| ||}} 
{{familytree |boxstyle=text-align: left; | | B01 | | | B02 | | B03 | | B04||B01=•PCN allergy: '''No'''<br> •MCL exposure: '''No'''<br> |B02=•PCN allergy: '''No'''<br> •MCL exposure: '''Yes'''<br> |B03=•PCN allergy: '''Yes'''<br> •MCL exposure: '''No'''<br> |B04=•PCN allergy: '''Yes'''<br> •MCL exposure: '''Yes'''<br> }}
{{familytree | | |!| | | | |!| | | |!| | | |!| ||}} 
{{familytree |boxstyle=text-align: left; | | B01 | | | B02 | | B03 | | B04||B01='''Recomended treatment:'''<br> •Bismuth quadruple <br> •Clarithromycin triple with amoxicillin<br> '''Other options''':<br> •Sequential<br> •HYBRID<br> •Levofloxacin triple<br> •Levofloxacin sequential <br>•LOAD<br> |B02='''Recomended treatment:'''<br>•Bismuth quadruple <br>•Levofloxacin sequential<br>'''Other options''':<br>•Concomitant therapy<br>•Sequential therapy <br>• HYBRID<br> •LOAD<br>|B03='''Recomended treatment:'''<br> •Bismuth quadruple <br> •Clarithromycin triple <br> with metronidazole<br> •Bismuth quadruple<br>|B04= '''Recomended treatment:''' <br> •Bismuth quadruple <br> •Clarithromycin triple with metronidazole<br> •Bismuth quadruple<br>}}
{{Familytree/end}}
 
 
 
{{familytree/start}}
{{familytree| | | | | | | | | | | | | | | | | | A01 | | | | | |A01=Persistent Helicobacter pylori infection }}
{{familytree| | | | | | | | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|.| |}}
{{familytree| | | | | | | | | B01 | | | | | | | | | | | | | | | | B02 ||B01=Patient recieved clarithromycin triple therapy|B02=Patient received Bismuth quadriple therapy }}
{{familytree| | |,|-|-|-|v|-|-|^|-|-|v|-|-|-|.| | | |,|-|-|-|v|-|-|^|-|-|v|-|-|-|.|}}
{{familytree|boxstyle=text-align: left; | C01 | | C02 | | | | C03 | | C04 | | C05 | | C06 | | | | C07 | | C08 | |C01= •No previous Quinolone exposure<br>•No PCN allergy<br>'''Recomended treatment:'''<br> •Bismuth quadruple<br> •Levofloxacin<br> •Rifabutin triple<br> •High dose dual|C02= •Previous Quinolone exposure<br> •No PCN Allergy<br>'''Recomended treatment:'''<br> •Bismuth quadruple therapy<br> •Rifabutin triple<br> •High dose dual<br>|C03= •No previous Quinolone exposure<br> •PCN Allergy<br> '''Recomended treatment:'''<br>•Bismuth quadruple| C04=•Previous Quinolone exposure<br> •PCN Allergy<br>'''Recomended treatment:'''<br> •Bismuth quadruple<br>|C05=•No previous Quinolone exposure<br>•No PCN allergy<br>'''Recomended treatment:'''<br>•Levofloxacin triple concomitant<br>•Rifabutin triple<br>•High dose triple<br>|C06=•Previous Quinolone exposure<br> •No PCN Allergy<br>'''Recomended treatment:'''<br>•Concomitant Rifabutin triple <br>•High dose dual<br>|C07=•No previous Quinolone<br> exposure<br> •PCN Allergy<br> '''Recomended treatment:'''<br>•PPI,Clarithromycin<br>,Metronidazole<br>•PPI,Levofloxacin,<br>Metronidazole|C08=•Previous Quinolone exposure<br> •No PCN Allergy<br>'''Recomended treatment:'''<br> •PPI,Clarithromycin,<br>Metronidazole<br>•Bismuth quadruple }}
{{familytree/end}}
 
 
===Diagnostic testing===
The American Journal of Gastroenterology guidelines recommend that '''endoscopy''' should be performed to rule out [[peptic ulcer disease]], esophagogastric [[malignancy]], and other rare upper gastrointestinal tract disease in the following settings:
* [[Dyspeptic]] patients <u>more than 55 years old</u> {{or2}}
* [[Dyspeptic]] patients with <u>alarm features</u>
:* [[Bleeding]]
:* [[Anemia]]
:* [[Early satiety]]
:* Unexplained [[weight loss]] (> 10% body weight)
:* Progressive [[dysphagia]]
:* [[Odynophagia]]
:* Persistent [[vomiting]]
:* A family history of gastrointestinal cancer
:* Previous esophagogastric [[malignancy]]
:* Previous documented [[peptic ulcer]], [[lymphadenopathy]], or an abdominal mass
 
In patients aged 55 years or younger with no alarm features, two management options may be considered:
* '''Test-and-treat strategy''' using a validated noninvasive test (urea breathing test or stool antigen test) for ''[[H. pylori]]'' and a trial of acid suppression if eradication is successful but symptoms do not resolve – preferable in populations with a moderate to high prevalence of ''[[H. pylori]]'' infection (≥ 10%)
* '''Empiric trial of acid suppression''' with a [[proton pump inhibitor]] for 4–8 weeks – preferable in low prevalence situations
 
Repeat [[endoscopy]] is not recommended once a firm diagnosis of functional [[dyspepsia]] has been established, unless new symptoms or alarm features develop.<ref>{{Cite journal| doi = 10.1111/j.1572-0241.2005.00225.x| issn = 0002-9270| volume = 100| issue = 10| pages = 2324–2337| last1 = Talley| first1 = Nicholas J.| last2 = Vakil| first2 = Nimish| last3 = Practice Parameters Committee of the American College of Gastroenterology| title = Guidelines for the management of dyspepsia| journal = The American Journal of Gastroenterology| date = 2005-10| pmid = 16181387}}</ref>  Testing to prove ''[[H. pylori]]'' eradication is most accurate if performed 4 weeks after the completion of therapy.<ref>{{Cite journal| doi = 10.1136/gutjnl-2012-302084| issn = 1468-3288| volume = 61| issue = 5| pages = 646–664| last1 = Malfertheiner| first1 = Peter| last2 = Megraud| first2 = Francis| last3 = O'Morain| first3 = Colm A.| last4 = Atherton| first4 = John| last5 = Axon| first5 = Anthony T. R.| last6 = Bazzoli| first6 = Franco| last7 = Gensini| first7 = Gian Franco| last8 = Gisbert| first8 = Javier P.| last9 = Graham| first9 = David Y.| last10 = Rokkas| first10 = Theodore| last11 = El-Omar| first11 = Emad M.| last12 = Kuipers| first12 = Ernst J.| last13 = European Helicobacter Study Group| title = Management of Helicobacter pylori infection--the Maastricht IV/ Florence Consensus Report| journal = Gut| date = 2012-05| pmid = 22491499}}</ref>

Latest revision as of 14:48, 30 October 2017

The ACG’s 2007 treatment guideline on the management of H. pylori infection (26) listed the following as established indications for diagnosis and treatment:

Indications

  • Active PUD (gastric or duodenal).
  • Confirmed history of PUD (not previously treated for H. pylori)
  • Gastric MALT lymphoma (low grade)
  • After endoscopic resection of EGC

Recommended first-line treatment for Helicobacter pylori

Regimen Drug dose Dosing frequency Duration(days) FDA approval
Clarithromycin triple PPI(standard or double dose

Clarithromycin(500mg)

Amoxicillin(1gm)or Metronidazole(500mg TID)

BID 14 days YES
Bismuth Quadruple PPI(standard dose)

Bismuth subcitrate (120-300mg)or Subsalicylate (300mg)

Tetracyclin(500mg)

Metronidazole(250-500mg)

BID

QID

QID

TID to QID (500mg)

10-14 days NO
Concomitant PPI (standard dose)

Clarithromycin (500mg)

Amoxicillin(1gm)

Nitroimidazole(500mg)

BID 10 -14 days NO
Sequential PPI(standard dose)+Amoxicillin(1gm)

PPI,Clarithromycin(500mg)+Nitroimidazole(500mg)

BID

BID

5-7 days

5-7 days

NO
Hybrid PPI(standard)+Amoxicillin(1gm)

PPI,Amoxicillin,Clarithromycin(500mg),Nitroimidazole(500mg)

BID

BID

7 days

7 days

NO
Levofloxacin triple PPI(standard dose)

Levofloxacin(500mg)

Amoxicillin(1gm)

BID

QID

BID

10-14 days NO
Levofloxacin sequential PPI(standard or double dose)+Amoxicillin(1 gm)

PPI,Amoxicillin,Levofloxacin(500mg QD),Nitroimidazole(500mg)

BID

BID

5-7 days NO
LOAD Levofloxacin(250mg)

PPI(double dose)

Nitazoxanide(500mg)

Doxycycline(100mg)

QD

QD

BID

QD

7-10 days NO

: Several PPI, Clarithromycin, and Amoxicillin combinations have achieved FDA approval ,PPI, Clarithromycin, Metronidazole is not an FDA approved treatment regimen.

‡: PPI, Bismuth, Tetracycline and metronidazole prescribed separately is not an FDA approved treatment regimen.However ,Pylera, a combination product containing Bismuth subcitrate,Tetracycline , Metronidazole combination with PPi for 10 days is an FDA approved regimen.

Adjuvant therapy in the treatment of H. pylori infection:

Emerging evidence suggests an inhibitory effect of Lactobacillus and Bifidobacterium species on H. pylori. Furthermore, these probiotic strains may also help to reduce the side effects of eradication therapies and improve compliance with therapy.

Selection of firstline Treatment

 
 
 
 
 
 
 
 
•Is there a penicillin (PCN) allergy?
•Previous macrolide (MCL) exposure for any reason ?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
•PCN allergy: No
•MCL exposure: No
 
 
•PCN allergy: No
•MCL exposure: Yes
 
•PCN allergy: Yes
•MCL exposure: No
 
•PCN allergy: Yes
•MCL exposure: Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Recomended treatment:
•Bismuth quadruple
•Clarithromycin triple with amoxicillin
Other options:
•Sequential
•HYBRID
•Levofloxacin triple
•Levofloxacin sequential
•LOAD
 
 
Recomended treatment:
•Bismuth quadruple
•Levofloxacin sequential
Other options:
•Concomitant therapy
•Sequential therapy
• HYBRID
•LOAD
 
Recomended treatment:
•Bismuth quadruple
•Clarithromycin triple
with metronidazole
•Bismuth quadruple
 
Recomended treatment:
•Bismuth quadruple
•Clarithromycin triple with metronidazole
•Bismuth quadruple


 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Persistent Helicobacter pylori infection
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Patient recieved clarithromycin triple therapy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Patient received Bismuth quadriple therapy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
•No previous Quinolone exposure
•No PCN allergy
Recomended treatment:
•Bismuth quadruple
•Levofloxacin
•Rifabutin triple
•High dose dual
 
•Previous Quinolone exposure
•No PCN Allergy
Recomended treatment:
•Bismuth quadruple therapy
•Rifabutin triple
•High dose dual
 
 
 
•No previous Quinolone exposure
•PCN Allergy
Recomended treatment:
•Bismuth quadruple
 
•Previous Quinolone exposure
•PCN Allergy
Recomended treatment:
•Bismuth quadruple
 
•No previous Quinolone exposure
•No PCN allergy
Recomended treatment:
•Levofloxacin triple concomitant
•Rifabutin triple
•High dose triple
 
•Previous Quinolone exposure
•No PCN Allergy
Recomended treatment:
•Concomitant Rifabutin triple
•High dose dual
 
 
 
•No previous Quinolone
exposure
•PCN Allergy
Recomended treatment:
•PPI,Clarithromycin
,Metronidazole
•PPI,Levofloxacin,
Metronidazole
 
•Previous Quinolone exposure
•No PCN Allergy
Recomended treatment:
•PPI,Clarithromycin,
Metronidazole
•Bismuth quadruple
 


Diagnostic testing

The American Journal of Gastroenterology guidelines recommend that endoscopy should be performed to rule out peptic ulcer disease, esophagogastric malignancy, and other rare upper gastrointestinal tract disease in the following settings:

In patients aged 55 years or younger with no alarm features, two management options may be considered:

  • Test-and-treat strategy using a validated noninvasive test (urea breathing test or stool antigen test) for H. pylori and a trial of acid suppression if eradication is successful but symptoms do not resolve – preferable in populations with a moderate to high prevalence of H. pylori infection (≥ 10%)
  • Empiric trial of acid suppression with a proton pump inhibitor for 4–8 weeks – preferable in low prevalence situations

Repeat endoscopy is not recommended once a firm diagnosis of functional dyspepsia has been established, unless new symptoms or alarm features develop.[1] Testing to prove H. pylori eradication is most accurate if performed 4 weeks after the completion of therapy.[2]

  1. Talley, Nicholas J.; Vakil, Nimish; Practice Parameters Committee of the American College of Gastroenterology (2005-10). "Guidelines for the management of dyspepsia". The American Journal of Gastroenterology. 100 (10): 2324–2337. doi:10.1111/j.1572-0241.2005.00225.x. ISSN 0002-9270. PMID 16181387. Check date values in: |date= (help)
  2. Malfertheiner, Peter; Megraud, Francis; O'Morain, Colm A.; Atherton, John; Axon, Anthony T. R.; Bazzoli, Franco; Gensini, Gian Franco; Gisbert, Javier P.; Graham, David Y.; Rokkas, Theodore; El-Omar, Emad M.; Kuipers, Ernst J.; European Helicobacter Study Group (2012-05). "Management of Helicobacter pylori infection--the Maastricht IV/ Florence Consensus Report". Gut. 61 (5): 646–664. doi:10.1136/gutjnl-2012-302084. ISSN 1468-3288. PMID 22491499. Check date values in: |date= (help)