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.