General population screening for infection with Helicobacter pylori: a realistic option?

To consider the effectiveness of a community programme of Helicobacter pylori (H pylori) screening and eradication run in collaboration with general practitioners. Specifically, to assess numbers successfully eradicating H pylori and consequently reducing the prevalence of infection, and to identify and consider areas of poor compliance.

A large general practice in Market Harborough, Leicestershire, UK.

A general population sample of 4015 subjects aged 21-55 was offered a serological screening test for H pylori through their general practitioners. Those testing positive were offered a prescription for eradication treatment and an information pack designed to encourage good compliance. Successful eradication was assessed by a urea breath test.

The screening test was accepted by 1566 (39%) of those invited, with men and younger people least likely to attend. Of the 235 (15%) subjects who tested positive, 186 (79%) were treated and eradication was confirmed in 170 (95%) of the 179 subjects who had a urea breath test. Overall, eradication was confirmed in 4% (170/4015) of those offered screening. Assuming a 15% overall prevalence of H pylori infection, it is estimated that H pylori was eradicated in 29% of those infected in the target group.

When an intervention was used to encourage good compliance, the eradication rate was high. Effectiveness was limited most strongly by the acceptance rate for the screening test, but also by the rate of uptake of eradication treatment. If benefits of population screening can be shown, appropriate interventions to improve compliance in these areas would need consideration.