Benefits of mass eradication of H pylori infection

What are the benefits and risks of mass eradication of H pylori infection in the community? In this issue of Gut, Lee et al attempt to answer this question with a unique study from Taiwan. Mass eradication (chemoprevention) of H pylori infection was started from 2004 for 5000 residents of Matsu Island who were >30 years of age. The main outcome measures were changes in the prevalence and incidence of H pylori infection and premalignant gastric lesions before (1995–2003) and after (2004–2008) chemoprevention. Eradication of H pylori infection substantially reduced the incidence of H pylori infection, gastric atrophy and peptic ulcer disease within the relatively short time period of this study. The intervention did not reduce the incidence of intestinal metaplasia or decrease its histological severity, supporting the ‘point-of-no-return’ theory. There was an increase in incidence of oesophagitis after intervention (see table 1). This finding, in a population where gastric atrophy was prevalent, suggests a causal relationship between eradication and onset of oesophagitis. The findings of this study …