H. pylori eradication is indicated in which of the following conditions according to the Maastricht VI/Florence Consensus 2022?
- A Asymptomatic H. pylori positivity in a patient with no risk factors for gastric cancer
- B Non-ulcer dyspepsia only if uninvestigated dyspepsia >55 years
- C Long-term low-dose aspirin use with prior peptic ulcer disease ✓
- D Gastric MALT lymphoma stage IE only if low-grade
Explanation
The Maastricht VI/Florence 2022 consensus recommends H. pylori eradication in patients on long-term NSAIDs or aspirin who have a history of peptic ulcer disease — this significantly reduces recurrent ulcer complications (CURE-2 study). Other mandatory indications include: all peptic ulcers (active or past), gastric MALT lymphoma (all stages, all grades respond to eradication), early gastric cancer after resection, first-degree relatives of gastric cancer patients, atrophic gastritis, and as a 'test-and-treat' strategy in uninvestigated dyspepsia <55 years. Asymptomatic H. pylori positivity without other indications does not require eradication per all guidelines, though a 'screen-and-treat' population strategy is endorsed in high-prevalence areas.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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