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Effect of a Community Screening for Helicobacter pylori

A 5-Yr Follow-Up Study

Hansen, Jane M., M.D., Ph.D.1; Wildner-Christensen, Mette, M.D., Ph.D.1; Hallas, Jesper, M.D., D.Med. Sci.2; Schaffalitzky de Muckadell, Ove B., M.D., D.Med. Sci.1

American Journal of Gastroenterology: May 2008 - Volume 103 - Issue 5 - p 1106–1113
ORIGINAL CONTRIBUTION: STOMACH
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BACKGROUND Helicobacter pylori (H. pylori) screening and eradication may reduce the incidence of gastric cancer,

AND AIMS peptic ulcer, and ulcer complications, and it may reduce symptoms in a small proportion of individuals with functional dyspepsia. This study aimed to assess the effect of community H. pylori screening and treatment on the prevalence of dyspepsia, and as secondary outcomes, the effect on dyspepsia-related health-care consumption and quality of life over 5 yr.

METHODS In 1998–1999, individuals aged 40–65 yr were randomized to H. pylori screening and treatment or to the control group. Five years later, the participants were sent a questionnaire to assess the prevalence of dyspepsia and quality of life. In addition, we obtained information from registers on the use of endoscopies and prescription medication. An economic evaluation was done alongside the randomized trial.

RESULTS Of 12,530 participants attending the study at baseline, 11,065 (88%) were traced and contacted at the 5-yr follow-up. The response rate was 94%. At baseline, 17.5% in the screened group were H. pylori-positive. The absolute reduction in dyspepsia during the first year was 4% in the screened group, whereas no change was observed in the unscreened group; this rate remained constant during the next 4 yr. Quality of life did not change. A small effect was found for dyspepsia-related consultations and sick leave days, but not on the prescription rate of ulcer drugs. A 33% lower ulcer incidence (107 ulcers vs 148 ulcers) was seen in the screened group compared to the unscreened group.

CONCLUSION A population H. pylori screening and treatment program in an H. pylori low-prevalence area had only a modest, but insignificant, effect on the rate of dyspepsia, and a modest, significant effect on the consultation rate and sick leave days for dyspepsia, but resulted in a decreased ulcer incidence. The intervention resulted in an increased cost due to H. pylori screening and treatment.

1Department of Medical Gastroenterology S, Odense University Hospital and 2Department of Clinical Pharmacology, University of Southern Denmark, Odense, Denmark

Reprint requests and correspondence: Jane M. Hansen, M.D., Ph.D., Department of Medical Gastroenterology S, Odense University Hospital, 5000 Odense C, Denmark.

Received June 6, 2007; accepted November 29, 2007.

© The American College of Gastroenterology 2008. All Rights Reserved.
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