Is there a rationale for eradication of Helicobacter pylori? Cost-benefit: the case for

Screening and treating the community for Helicobacter pylori would have seemed inconceivable 5 years ago. This has now become a real possibility given that H. pylori is a major risk factor for gastric carcinoma. Screening should not be introduced, however, before the costs and benefits of the programme are established. It has been estimated that 1:30-1:60 of the UK population die from an H. pylori related disease. If treating H. pylori were to reduce premature mortality, then this would be a persuasive argument for a screening strategy. The financial costs of screening and treating H. pylori are significant but this would be partially offset by savings that would accrue from reducing dyspepsia in the community. Indeed, decision analysis models suggest H. pylori screening is cost-effective. The potential benefits are enormous and prospective randomised trials are urgently required to establish whether such a programme is worthwhile.