Should we go further and screen and treat?

Helicobacter pylori is probably the most common human bacterial infection in the world, and, in a minority of infected individuals, it can cause life-threatening disease. As testing procedures and treatment regimens become cheaper and more reliable, is the screening of asymptomatic populations to identify and treat infected individuals justified? Evidence on which to base an answer to this question is sparse, but there are several reasons to believe that a screen-and-treat strategy for H. pylori infection might constitute a viable public health intervention. Screening can be sensitive, H. pylori eradication regimens are increasingly effective, and both screening for and eradicating the bacterium are relatively inexpensive. There are, however, a number of concerns that can be addressed only through further research. Decisive evidence concerning all the risks and benefits of a screen-and-treat strategy will be derived only from large, long-term, randomized, controlled trials.