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Review: Eradication of Helicobacter pylori to prevent gastroduodenal diseases: Hitting more than one bird with the same stone

Departments of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan, Division of Biostatistics, Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan

Jyh-Ming Liou

Departments of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

Chun-Ying Wu

Department of Internal Medicine, Veteran General Hospital, Taichung, Taiwan, Departments of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

Jaw-Town Lin

Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan, Department of Internal Medicine, E-DA Hospital/Kaohsiung County I-Shou University No. 7, Chung-Shan South Road, Taipei, Taiwanjawtown{at}ntu.edu.tw

Helicobacter pylori (H. pylori ) are gram-negative bacteria that selectively colonizes the gastric mucosa. The prevalence of H. pylori infection varies from 20 to 50% in industrialized countries to over 80% in developing countries. The infection may persist lifelong without specific treatment. Prolonged infection and inflammation due to bacterial virulence and host genetic factors will lead to chronic gastritis. A certain portion of infected patients then develop more severe pathologies such as peptic ulcer (10—15%), gastric cancer (1%), and mucosa-associated lymphoid tissue lymphoma (<0.01%). Although the majority of infected patients remain asymptomatic, much of the evidence has shown that eradication of H. pylori infection can reduce the recurrence of peptic ulcer and benefit a substantial portion of patients with nonulcer dyspepsia. Though controversial in population-based clinical trials, several cost-effectiveness analyses also reveal that H. pylori eradication is cost effective in the primary prevention of gastric cancer. Therefore, the discovery of H. pylori offers the chance to prevent several gastroduodenal diseases by means of their eradication. In other words, gastroenterologists could hit more than one bird with one stone. However, there are concerns regarding application of a 'test and treat' strategy in the general population. In this review, we will focus on current evidence of H. pylori eradication in the primary and secondary prophylaxis of gastric cancer and peptic ulcer disease.

Key Words: Helicobacter pylori • eradication • gastric cancer • peptic ulcer • nonulcer dyspepsia • prevention

Therapeutic Advances in Gastroenterology, Vol. 1, No. 2, 111-120 (2008)
DOI: 10.1177/1756283X08094880


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