The disease burden of Helicobacter pylori beyond gastric cancer

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BACKGROUND & AIMS: Although Helicobacter pylori screenand-treat has demonstrated effectiveness in preventing gastric cancer (GC), the impact on other diseases, such as peptic ulcer disease (PUD), dyspepsia, and gastric lymphomas, is often overlooked in guidelines and policy-analyses. This study quantifies the disease burden attributable to H pylori beyond GC. METHODS: A systematic literature search identif ied studies reporting the relative risk of developing PUD, dyspepsia, or gastric lymphomas due to H pylori to calculate the population attributable fraction (PAF) for each condition. The PAF represents the proportion of disease burden caused by H pylori. Preventable case numbers were calculated based on the risk reduction from eradication, both globally and specific for countries with varying H pylori prevalence. RESULTS: The proportions of PUD, dyspepsia, and gastric lymphoma attributable to H pylori (95% confidence interval) were 57% (44%–68%), 7% (2%–13%), and 33% (12%–53%), respectively, corresponding to 3.5 (2.7–4.2) million, 30 (7.152.2) million, and 12,000 (4200–19,100) cases potentially preventable through eradication, globally. Country-specific estimates varied with lowest PAFs (PUD, dyspepsia, gastric lymphomas) observed in the United States (35% [24%–47%], 3% [2%–13%], and 17% [5%–31%]) and highest in South Korea (63% [50%–73%], 9% [2%–15%], and 39% [14%58%]). However, even in the United States, preventable case numbers remained substantial for PUD (134,000 [93,000177,000]) and dyspepsia (860,000 [196,000–1.5 million]). CONCLUSIONS: Omitting PUD and dyspepsia as outcomes in studies on H pylori screen-and-treat may substantially underestimate benefits. Incorporating these diseases alongside GC into cost-effectiveness and policy analyses, therefore, may improve the evaluation of H pylori screen-and-treat programs. The actual benefit depends on the extent to which H pylori triggers an irreversible pathway to disease early in life.

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