The investigation and treatment of Helicobacter pylori for the prevention of gastric cancer: A narrative review and assessment of management approaches.

Background The rate of gastric cancer(GC) has reduced globally in all ages in recent years, but some data has started to emerge of a reversal in those >50 years, particularly in wealthier countries. H. pylori(HP) infection is associated with 89% of GC diagnoses, and its eradication is associated with a clear risk-reduction. The approach to diagnosis varies globally, however recently IARC haas reccommended screening in all populations. Summary A test-and-treat approach towards symptomatic young people is advocated among European populations, and has been shown to improve dyspepsia and reduce costs. Its impact on GC rates are less clear. Studies in high-incidence countries have demonstrated cost-effective, real-world reductions in GC rates with population-based HP screening(screen-and-treat). Abundant modelling data in these countries show economic benefits to nearly all screening programs, however, data in European populations, at lower risk, is lacking. Modelled data suggests it may be feasible, but currently no guidelines recommend a specific approach. Prospective European studies are underway to assess the feasibility of various screening methods. We discuss the evidence behind both approaches and the use of both endoscopy(Test-scope-and-treat) and biomarkers as adjuncts to population-based screening to maximise gastric cancer reduction from any future European screening programme. Key Messages Prospective data from H. pylori high-incidence countries have shown a clear cost-effective reduction in gastric cancer diagnoses after introduction of population-screening. Modelled data from H. pylori low-incidence countries shows population-based screening may be cost effective, but real-world feasibility data is lacking.