Evolving Concepts in Helicobacter pylori Management

Authors

Steven F Moss
Shailja C Shah
Mimi C Tan
Hashem B El-Serag

Publication Date

2-1-2024

Journal

Gastroenterology

DOI

10.1053/j.gastro.2023.09.047

PMID

37806461

PMCID

PMC10843279

PubMedCentral® Posted Date

2-1-2025

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Humans, Ethnicity, Stomach Neoplasms, Minority Groups, Risk Factors, Helicobacter Infections, Anti-Bacterial Agents, Helicobacter pylori, gastric cancer, gastric cancer screening, H. pylori treatment, antibiotic resistance, susceptibility testing, gastric intestinal metaplasia, underrepresented minorities

Abstract

Helicobacter pylori is the most common chronic bacterial infection worldwide and the most significant risk factor for gastric cancer, which remains a leading cause of cancer-related death globally. H pylori and gastric cancer continue to disproportionately impact racial and ethnic minority and immigrant groups in the United States. The approach to H pylori case-finding thus far has relied on opportunistic testing based on symptoms or high-risk indicators, such as racial or ethnic background and family history. However, this approach misses a substantial proportion of individuals infected with H pylori who remain at risk for gastric cancer because most infections remain clinically silent. Moreover, individuals with chronic H pylori infection are at risk for gastric preneoplastic lesions, which are also asymptomatic and only reliably diagnosed using endoscopy and biopsy. Thus, to make a significant impact in gastric cancer prevention, a systematic approach is needed to better identify individuals at highest risk of both H pylori infection and its complications, including gastric preneoplasia and cancer. The approach to H pylori eradication must also be optimized given sharply decreasing rates of successful eradication with commonly used therapies and increasing antimicrobial resistance. With growing acceptance that H pylori should be managed as an infectious disease and the increasing availability of susceptibility testing, we now have the momentum to abandon empirical therapies demonstrated to have inadequate eradication rates. Molecular-based susceptibility profiling facilitates selection of a personalized eradication regimen without necessitating an invasive procedure. An improved approach to H pylori eradication coupled with population-level programs for screening and treatment could be an effective and efficient strategy to prevent gastric cancer, especially in minority and potentially marginalized populations that bear the heaviest burden of H pylori infection and its complications.