Who should be treated for Helicobacter pylori infection?

Abstract

Helicobacter pylori infection affects approximately half of the worldԸ?s population. In Hong Kong, approximately 55% of the population is infected with this organism. But symptoms and clinical disease develop in only a minority of infected individuals during their lifetime. Treatment should thus be appropriately targeted. It is imperative that infected patients who have either a current or past history of peptic ulcer disease, with or without bleeding or a perforation complication, and those with low-grade gastric, mucosal-associated lymphoid tissue lymphoma should all have the organism eliminated. There is evidence that antiԸ?Helicobacter pylori therapy reduces the recurrence of gastric cancer after the successful removal of early gastric cancer lesions. Patients with non-ulcer dyspepsia, particularly those with severe symptoms, should also be considered for a trial of eradication therapy. Whether or not eradication therapy should be given to those who require long-term non-steroidal anti-inflammatory drug therapy, but who do not have a history of peptic ulcer disease is still not decided. The use of prophylactic eradication to stop the development of gastric cancer or peptic ulceration in H pylori--positive but asymptomatic individuals should be considered only in research settings.