Global whole family based- Helicobacter pylori eradication strategy to prevent its related diseases and gastric cancer

Abstract

Helicobacter pylori (H. pylori) infects approximately 50% of the world population. The multiple gastrointestinal and extra-gastrointestinal diseases caused by H. pylori infection pose a major healthcare threat to families and societies; it is also a heavy economic and healthcare burden for countries that having high infection rates. Eradication of H. pylori is recommended for all infected individuals. Traditionally, "test and treat" and "screen and treat" strategies are available for various infected populations. However, clinical practice has noticed that these strategies have some shortfalls and may need refinement, mostly due to the fact that they are not easily manageable, and are affected by patient compliance, selection of treatment population and cost-benefit estimations. Furthermore, it is difficult to control infections from the source, therefore, development of additional, compensative strategies are encouraged to solve the above problems and facilitate bacteria eradication. H. pylori infection is a family-based disease, but few studies have been performed in a whole family-based approach to curb its intra-familial transmission and the development of related diseases. In this work, a third, novel whole family-based H. pylori eradication strategy is introduced. This approach screens, identifies, treats and follows up on all H. pylori-infected individuals in entire families to control H. pylori infection among family members, and reduce its long-term complications. This strategy is high-risk population-oriented, and able to reduce H. pylori spread among family members. It also has good patient-family compliance and, importantly, is practical for both high and low H. pylori-infected communities. Future efforts in these areas will be critical to initiate and establish healthcare policies and management strategies to reduce H. pylori-induced disease burden for society.

Keywords: Helicobacter pylori; Gastric cancer; Gastrointestinal disease; Intra-familial infection.

Figure 1

Flow chart of whole family-based Helicobacter pylori infection management strategy. In a typical gastroenterology clinic, visiting patients are questioned for symptoms and signs, and Helicobacter pylori (H. pylori) infection is tested. If the patient is H. pylori positive, the related family members are recommended to test H. pylori either by serological, stool antigen or urease breath tests, or both; this could include parents, spouses, children, or other members living in the same household. The infected family members are recommended to treat the infection, ideally at the same time, and follow up. If patients are confirmed as H. pylori negative, just following up without treatment is required. ¹Screen test for family members can be urease breath tests, or various antibody tests. H. pylori: Helicobacter pylori.