Screening for Helicobacter pylori : studies in two population samples from central England
thesisposted on 15.12.2014, 10:31 by Margaret A. Stone
If it is clearly demonstrated that eradicating Helicobacter pylori (H pylori) in asymptomatic subjects would lead to a reduction in morbidity and mortality, population screening may become justified. It must also, however, be shown that prevalence of infection can be effectively reduced; these studies addressed the hypothesis that this can be achieved through community screening and eradication.;A serological screening test for infection with H. pylori was offered in two community programmes in Market Harborough and Belgrave. Those testing positive were offered a prescription for eradication therapy and successful eradication was assessed by urea breath testing. Consideration was given to compliance at each stage, also to the association between dyspepsia and H. pylori and to risk factors for infection. For possible long-term follow-up regarding health benefits, subjects in Market Harborough were randomised to be offered screening or to a matched control group not invited.;The feasibility of community screening and eradication was demonstrated. Compliance with medication (100% in Market Harborough, 95% in Belgrave) and eradication rates (95%, 92%) were good in those who accepted therapy. Uptake of screening (39%, 26%) and therapy (79%, 81%) were however limited, with men and younger people less likely to attend. In Belgrave, low uptake was influenced by the inaccuracy of the mailing list, but attendance was similar in Asians and non-Asians and was not improved by the use of Asian Language materials.;No correlation was found between infection with H. pylori and overall symptoms of dyspepsia (P=0.626 after adjustments). Using logistic regression, the association between the infection and childhood living conditions was confirmed. Intrafamilial transmission was suggested by an association between H. pylori status of self and spouse in married couples (odds ratio 2.65 after adjustments). Asian ethnicity was not a risk factor for infection in Belgrave (X2=0.31, P=0.611).