Can therapy ever be denied for Helicobacter pylori infection?

Helicobacter pylori infection is a transmissible bacterial infection of the gastric mucosal surface that causes progressive damage with eventual destruction of the stomach. In the United States, the presence of H. pylori infection in patients carries a lifetime risk of developing peptic ulcer of at least 16% and a 1%-3% risk of developing gastric cancer. An infected individual is also a risk to the community because the infection can be transmitted. A review of the data shows that H. pylori is the only treatable infectious disease with such a high rate of morbidity and mortality that is not the subject of an all-out program to eradicate it from the population. The risk of a serious outcome of untreated asymptomatic H. pylori infection is great, or greater, than with asymptomatic syphilis or tuberculosis. H. pylori infection is a serious public health problem, and thus the presence of H. pylori infection justifies treatment. The question is not whom to treat, but whom to test. The gastroenterology community appears to have been unduly influenced by the fact that H. pylori infection is widespread and often asymptomatic, as well as by the costs and complications of current treatment. H. pylori infection is a serious, worldwide infectious disease with tremendous and unacceptable morbidity and mortality. Although there are no emotional reasons to treat H. pylori infection, there are logical and persuasive scientific reasons to treat. If the tools are available, screening the population for the presence of H. pylori infection with the goal of preventing all H. pylori-related diseases is recommended. Our goal should be to totally eliminate H. pylori from the face of the earth, just as we eliminated smallpox.