Author's reply

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6947.132c (Published 09 July 1994) Cite this as: BMJ 1994;309:132
  1. D Colin-Jones
  1. Consultant physician Queen Alexandra Hospital, Portsmouth PO6 3LY.

    EDITOR,—A television documentary of this kind cannot be the medium for full scientific rigour and should therefore avoid drawing unwarranted conclusions. In this case many of the conclusions were indeed warranted, and my review gave congratulation where it was due for an important and advancing subject being opened to general view. My dispute with Michael Mosley is that on some points the evidence is at an early stage and open to a range of interpretations. In particular, eradication of Helicobacter pylori depends on several factors, such as patients’ compliance with a complex regimen, the treatment chosen, and antibiotic sensitivity. For example, triple treatment was successful in 90% of cases when the organism was sensitive to metronidazole but only 31% when it was resistant.1 Some studies have achieved eradication rates of 90%, but many more have reported much lower figures.

    The link between H pylori and gastric cancer has been well made and was portrayed accurately. Eradication of the infection when it has been present for many years has not, however, been shown to prevent a cancer developing. The gastritis caused by H pylori often progresses to gastric atrophy, which is thought to be irreversible. At what stage will eradication prevent a cancer developing? Presumably before the atrophy develops. As a result of the documentary I have already had inquiries from patients about preventing gastric cancer, but we simply do not yet know if this can be achieved in someone with an established infection.

    Unfortunately, Mosley does not quote my review accurately. Half the middle aged population of Britain have H pylori infection without apparent adverse effects—that is, they are unaware of it as it is asymptomatic. There are no convincing data linking H pylori with non-ulcer dyspepsia.

    Mosley's letter tries to make my review seem harsh and critical, but this was not the case. I tried to emphasise the enthusiasm that he communicated. I complimented the film and discussed the impact that this remarkable organism is having on our thinking and clinical practice.


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