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  • Review Article
  • Published:

Population screening and treatment of Helicobacter pylori infection

Nature Reviews Gastroenterology & Hepatology volume 14, pages 230–240 (2017)Cite this article

Subjects

Key Points

  • Helicobacter pylori is an important cause of gastric cancer, as well as benign diseases such as peptic ulcer and dyspepsia

  • The eradication of H. pylori leads to a reduced risk of gastric cancer and can cure peptic ulcer and dyspepsia

  • H. pylori is negatively associated with conditions such as GERD, obesity and asthma; concerns have been raised about the effect of a mass treatment programme on burden of these diseases, as well as antimicrobial resistance and microbiota

  • Population screening and treatment of H. pylori as a means of preventing gastric cancer fulfils the Wilson and Jungner criteria for a successful screening programme

  • Serological testing for H. pylori seems to be the most cost-effective means of delivering such a screening programme

  • Population screening and treatment of H. pylori infection to control gastric cancer is cost-effective in high-risk populations; in countries with a lower incidence, cost-effectiveness might depend on reduction of burden of non-malignant diseases (e.g. peptic ulcer and dyspepsia)

Abstract

Helicobacter pylori is an important human pathogen, associated with a substantial burden from both malignant and non-malignant diseases. The bacterium is classed as a human carcinogen, being strongly linked with gastric cancer, the third most common cause of cancer death worldwide and is also associated with common conditions such as dyspepsia and peptic ulcer. Eradication of H. pylori reduces the incidence of gastric cancer and peptic ulcer, as well as the prevalence and costs of managing dyspepsia. Economic analyses suggest that eradication of H. pylori as a means of controlling gastric cancer is cost-effective in high-risk populations. Even in populations at low risk of gastric cancer, there might be other benefits arising from screening and treatment, owing to the effects on non-malignant upper gastrointestinal diseases. However, public health authorities have been slow to consider the benefits of population-based screening and treatment as a means of reducing the morbidity and mortality associated with the infection. There are also concerns about widespread use of eradication therapy, including antimicrobial resistance and a rise in the prevalence of diseases that are negatively associated with H. pylori, such as GERD, Barrett oesophagus, asthma and obesity. This Review summarizes these issues.

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Figure 1: Global incidence of gastric cancer in 2012.
Figure 2: A model for the development of gastric cancer.
Figure 3: Potential beneficial and deleterious effects of population screening and treatment of H. pylori infection.

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Authors and Affiliations

  1. Leeds Gastroenterology Institute, Level 4, Bexley Wing, St James's University Hospital, Beckett Street Leeds, LS9 7TF, UK

    Anthony O'Connor & Alexander C. Ford

  2. Tallaght Hospital/Trinity College Dublin, Belgard Road, Dublin, 24, Dublin, Ireland

    Anthony O'Connor & Colm A. O'Morain

  3. Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, LS2 9JT, UK

    Alexander C. Ford

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O'Connor, A., O'Morain, C. & Ford, A. Population screening and treatment of Helicobacter pylori infection. Nat Rev Gastroenterol Hepatol 14, 230–240 (2017). https://doi.org/10.1038/nrgastro.2016.195

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