Impact of Helicobacter pylori on society—role for a strategy of ‘search and eradicate’

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Abstract
Helicobacter pylori infection is causally related to gastric cancer, a malignancy associated with high morbidity and poor prognosis, and to peptic ulcer disease, a disease with high morbidity and modest mortality. Theoretically, H. pylori eradication is the most practical means of preventing gastric cancer and peptic ulcer disease. From a public policy perspective, the current evidence is insufficient to assess accurately the magnitude of the benefits of a universal ‘search and treat’ approach. Nonetheless, it is possible to identify high‐risk patients for whom testing for the presence of H. pylori infection, with the intention‐to‐treat infected individuals is currently indicated. This list includes patients with ulcers or dyspepsia, first‐degree relatives of patients with peptic ulcer or gastric cancer, gastric cancer patients after potentially curative resection of their gastric cancer, patients in whom long‐term acid antisecretory therapy or long‐term nonsteroidal anti‐inflammatory drug therapy (including low‐dose aspirin) is planned, and finally those who desire testing. Population screening among asymptomatic individuals with a high risk of gastric cancer, such as Korean‐ and Japanese‐Americans, appears logical, but from a public health perspective should be done as a component of controlled intervention studies. There are no known H. pylori infections without risk of a symptomatic outcome, therefore screening represents a rational strategy for cancer prevention. Adoption of such a policy will require carefully balancing the costs of the programme with its benefits.