Letters Diagnosis of Helicobacter pylori infection

Should H pylori always be eradicated?

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2145 (Published 21 March 2012) Cite this as: BMJ 2012;344:e2145
  1. Ruchit Sood, specialist registrar in gastroenterology
  1. 1York Teaching Hospital, York YO31 8HE, UK
  1. ruchitsood{at}gmail.com

Braden’s article raises the interesting question of whether we should always aim to eradicate Helicobacter pylori when present.1 There are times when it is clearly important to eradicate H pylori—for example, in patients with peptic ulcer disease, mucosa associated lymphoid tissue lymphoma, or an increased risk of gastric cancer. However, improvement in functional dyspepsia after eradication is modest at best, with symptoms improving in only 7% of people,2 and we should be wary of prescribing multiple courses of antibiotics with little evidence that they are useful. Increasing evidence suggests that H pylori protects against conditions such as gastro-oesophageal reflux disease, and that as the prevalence of H pylori is decreasing that of gastro-oesophageal reflux disease seems to be increasing.3

We must exercise caution in advocating a blanket test and treat approach; perhaps in future, people at risk of serious H pylori associated sequelae will be identified and offered eradication therapy. The remaining people colonised with H pylori would then not run the risk of increased morbidity as a result of efforts at eradicating this organism.


Cite this as: BMJ 2012;344:e2145


  • Competing interests: None declared.


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