Beyond Gastric Cancer: The True Burden of H. pylori- Gastroenterology Feb.26

Introduction

Helicobacter pylori is universally recognised as a major cause of gastric cancer, and screen-and-treat strategies are often evaluated almost exclusively through this lens. However, H. pylori also drives a broad spectrum of other gastrointestinal diseases—many far more common than cancer—that substantially affect patients, healthcare systems, and quality of life.

This study asks an important but often ignored question:

How much disease burden attributable to H. pylori are we overlooking when we focus only on gastric cancer?

The problem with current policy thinking

Most cost-effectiveness models and guideline discussions around H. pylori eradication prioritise:

gastric cancer incidence and mortality.

What they frequently exclude or underweight:

peptic ulcer disease (PUD),

functional dyspepsia, and

gastric lymphomas (eg, MALT lymphoma).

As a result, the true public-health benefit of eradication is likely underestimated, especially in countries with moderate H. pylori prevalence.

What the authors did:

Performed a systematic review of studies linking H. pylori to PUD, dyspepsia, and gastric lymphoma.

Calculated population attributable fractions (PAF)—the proportion of disease directly caused by H. pylori.

Estimated how many cases of each condition could be prevented through eradication, both globally and in individual countries with different H. pylori prevalence.

Key findings clinicians and policymakers should grasp

1) H. pylori drives a large share of ulcer disease worldwide

More than half of peptic ulcer disease globally is attributable to H. pylori. This translates into millions of preventable ulcer cases—far exceeding the absolute number of gastric cancers prevented.

2) Dyspepsia matters—even with lower attributable fractions

Although only a smaller proportion of dyspepsia is attributable to H. pylori, the sheer prevalence of dyspepsia means that tens of millions of cases worldwide could potentially be prevented or improved with eradication.

3) Gastric lymphoma prevention is real, though less frequent

A meaningful fraction of gastric lymphomas—rare but serious—are also attributable to H. pylori, reinforcing eradication as a cancer-prevention strategy beyond adenocarcinoma.

4) Benefits persist even in low-prevalence countries

Even in countries like the United States, where H. pylori prevalence is relatively low, preventable numbers of ulcers and dyspepsia cases remain substantial. This challenges the notion that eradication only “makes sense” in high-prevalence Asian settings.

This paper reframes H. pylori eradication as:

not just a cancer-prevention tool, but

a multidisease prevention strategy with broad population-level benefits.

When PUD and dyspepsia are included:

The health gains increase dramatically,

Cost-effectiveness improves, and

screen-and-treat strategies may be justified in a wider range of healthcare systems.

Key nuance: timing matters

The authors rightly caution that the true benefit depends on biology:

If H. pylori triggers irreversible disease pathways early in life, later eradication may not fully prevent disease.

This highlights the importance of early-life or young-adult eradication strategies in future models.

Bottom-line takeaway:

By focusing only on gastric cancer, we are substantially underestimating the public-health value of H. pylori eradication. Including peptic ulcer disease and dyspepsia fundamentally changes the balance in favour of broader screen-and-treat strategies.

One-line GastroAGI takeaway

H. pylori eradication prevents far more disease than gastric cancer alone—and policy models should reflect that reality.