Leeds Gastroenterology Institute, Level 4, Bexley Wing, St James's University Hospital, Beckett Street Leeds, LS9 7TF, UK.
Tallaght Hospital/Trinity College Dublin, Belgard Road, Dublin 24, Dublin, Ireland.
Nat Rev Gastroenterol Hepatol. 2017 Apr;14(4):230-240. doi: 10.1038/nrgastro.2016.195. Epub 2017 Jan 5.
Helicobacter pylori is an important human pathogen, associated with a substantial burden from both malignant and non-malignant diseases. The bacterium is classed as a human carcinogen, being strongly linked with gastric cancer, the third most common cause of cancer death worldwide and is also associated with common conditions such as dyspepsia and peptic ulcer. Eradication of H. pylori reduces the incidence of gastric cancer and peptic ulcer, as well as the prevalence and costs of managing dyspepsia. Economic analyses suggest that eradication of H. pylori as a means of controlling gastric cancer is cost-effective in high-risk populations. Even in populations at low risk of gastric cancer, there might be other benefits arising from screening and treatment, owing to the effects on non-malignant upper gastrointestinal diseases. However, public health authorities have been slow to consider the benefits of population-based screening and treatment as a means of reducing the morbidity and mortality associated with the infection. There are also concerns about widespread use of eradication therapy, including antimicrobial resistance and a rise in the prevalence of diseases that are negatively associated with H. pylori, such as GERD, Barrett oesophagus, asthma and obesity. This Review summarizes these issues.
幽门螺杆菌是一种重要的人类病原体，与恶性和非恶性疾病都有很大的负担有关。该细菌被归类为人类致癌物，与胃癌密切相关，胃癌是全球第三大常见癌症死因，也与消化不良和消化性溃疡等常见疾病有关。根除幽门螺杆菌可降低胃癌和消化性溃疡的发病率，以及消化不良的患病率和管理成本。经济分析表明，在高危人群中，根除幽门螺杆菌作为控制胃癌的一种手段具有成本效益。即使在胃癌风险较低的人群中，由于对非恶性上消化道疾病的影响，也可能会因筛查和治疗而带来其他益处。然而，公共卫生当局一直迟迟没有考虑将人群筛查和治疗作为降低与感染相关的发病率和死亡率的一种手段。人们还担心广泛使用根除疗法，包括抗生素耐药性以及与幽门螺杆菌呈负相关的疾病（如 GERD、巴雷特食管、哮喘和肥胖症）的患病率上升。这篇综述总结了这些问题。
