Review article: impact of Helicobacter pylori on society-role for a strategy of 'search and eradicate'.

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.