GENERAL-POPULATION SCREENING FOR INFECTION WITH HELICOBACTER-PYLORI -A REALISTIC OPTION

Objectives-To consider the effectiveness of a community programme of H elicobacter pylori (H pylori) screening and eradication run in collabo ration with general practitioners. Specifically, to assess numbers suc cessfully eradicating H pylori and consequently reducing the prevalenc e of infection, and to identify and consider areas of poor compliance. Setting-A large general practice in Market Harborough, Leicestershire , UK. Methods-A general population sample of 4015 subjects aged 21-55 was offered a serological screening test for H pylori through their ge neral practitioners. Those testing positive were offered a prescriptio n for eradication treatment and an information pack designed to encour age good compliance. Successful eradication was assessed by a urea bre ath test. Results-The screening test was accepted by 1566 (39%) of tho se invited, with men and younger people least likely to attend. Of the 235 (15%) subjects who tested positive, 186 (79%) were treated and er adication was confirmed in 170 (95%) of the 179 subjects who had a ure a breath test. Overall, eradication was confirmed in 4% (170/4015) of those offered screening. Assuming a 15% overall prevalence of H pylori infection, it is estimated that H pylori was eradicated in 29% of tho se infected in the target group. Conclusions-When an intervention was used to encourage good compliance, the eradication rate was high. Effe ctiveness was limited most strongly by the acceptance rate for the scr eening test, but also by the rate of uptake of eradication treatment. If benefits of population screening can be shown, appropriate interven tions to improve compliance in these areas would need consideration.