Cost-Effectiveness of Population Screening for Helicobacter Pylori in Preventing Gastric Cancer and Peptic Ulcer Disease, Using Simulation

2003 ◽  
Vol 10 (3) ◽  
pp. 148-156 ◽  
Author(s):  
P Roderick ◽  
R Davies ◽  
J Raftery ◽  
D Crabbe ◽  
R Pearce ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Population Screening ◽  
Sensitivity Analyses ◽  
Ulcer Disease ◽  
H Pylori ◽  
The Cost

Objectives: To evaluate the cost-effectiveness of population screening for Helicobacter pylori in preventing gastric cancer and peptic ulcer disease in England and Wales. Methods: A discrete event simulation model used parameter estimates, derived from peer-reviewed literature, routine data and statistical modelling. Population screening was compared with no screening but with opportunistic eradication in patients presenting with dyspepsia. Costs included screening, eradication and costs averted to provide costs per life years saved (cost/LYSj for preventing gastric cancer and peptic ulcer disease. Sensitivity analyses were undertaken. Results: The cost/LYS from screening at age 40 years was £5860 at discount rates of 6%. The outcomes were sensitive to H. pylori prevalence, the degree of opportunistic eradication, the discount rate, the efficacy of eradication on gastric cancer risk, the risk of complicated peptic ulcer disease and gastric cancer associated with H. pylori infection, and the duration of follow-up. In sensitivity analyses, the cost/LYS rarely exceeded £20000 over an 80-year follow-up, but did for shorter periods. Conclusions: H. pylori screening may be cost-effective in the long term. However, before screening can be recommended further evidence is needed to resolve some of the uncertainties, particularly over the efficacy of eradication on risk of gastric cancer, the risk associated with complicated peptic ulcers, and the effect of more widespread opportunistic testing of patients with dyspepsia.

Cost-Effectiveness of Screening With Polymerase Chain Reaction For Helicobacter Pylori To Prevent Gastric Cancer And Peptic Ulcers

2021 ◽  
Author(s):  
Aaron Oh ◽  
Han Truong ◽  
Judith Kim ◽  
Sheila D. Rustgi ◽  
Julian A. Abrams ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Peptic Ulcer ◽  
Cost Effectiveness ◽  
Peptic Ulcer Disease ◽  
Cost Effective ◽  
Population Screening ◽  
Pcr Screening ◽  
Ulcer Disease ◽  
Polymerase Chain ◽  
H Pylori

Abstract Background: Helicobacter pylori is a major risk factor for gastric cancer. Screening and treatment of H. pylori may reduce the risk of gastric cancer and peptic ulcer disease. Polymerase chain reaction (PCR) of gastric biopsies provides superior sensitivity and specificity for the detection of H. pylori. This study explores whether population-based H. pylori screening with PCR is cost-effective in the US.Methods: A Markov cohort state-transition model was developed to compare three strategies: no screening with opportunistic eradication, 13C-UBT population screening and treating of H. pylori, and PCR population screening and treating of H. pylori. Estimates of risks and costs were obtained from published literature. Since the efficacy of H. pylori therapy in gastric cancer prevention is not certain, we broadly varied the benefit 30-100% in sensitivity analysis.Results: PCR screening was cost-effective and had an incremental-cost effectiveness ratio per quality adjusted life-year (QALY) of $38,591.89 when compared to 13C-UBT strategy with an ICER of $2373.43 per QALY. When compared to no screening, PCR population screening reduced cumulative gastric cancer incidence from 0.84% to 0.74% and reduced peptic ulcer disease risk from 14.8% to 6.0%. The cost-effectiveness of PCR screening was robust to most parameters in the model.Conclusion: Our modeling study finds PCR screening and treating of H. pylori to be cost-effective in the prevention of gastric cancer and peptic ulcer disease. However, the potential negative consequences of H. pylori eradication such as antibiotic resistance could change the balance of benefits of population screening.

scholarly journals The Human Gastric Pathogen Helicobacter pylori and Its Association with Gastric Cancer and Ulcer Disease

Ulcers ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-23 ◽  
Author(s):  
Bianca Bauer ◽  
Thomas F. Meyer
Keyword(s):  
Gastric Cancer ◽  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Strain Differences ◽  
Protective Effects ◽  
Ulcer Disease ◽  
Prophylactic Measures ◽  
H Pylori

With the momentous discovery in the 1980's that a bacterium, Helicobacter pylori, can cause peptic ulcer disease and gastric cancer, antibiotic therapies and prophylactic measures have been successful, only in part, in reducing the global burden of these diseases. To date, ~700,000 deaths worldwide are still attributable annually to gastric cancer alone. Here, we review H. pylori's contribution to the epidemiology and histopathology of both gastric cancer and peptic ulcer disease. Furthermore, we examine the host-pathogen relationship and H. pylori biology in context of these diseases, focusing on strain differences, virulence factors (CagA and VacA), immune activation and the challenges posed by resistance to existing therapies. We consider also the important role of host-genetic variants, for example, in inflammatory response genes, in determining infection outcome and the role of H. pylori in other pathologies—some accepted, for example, MALT lymphoma, and others more controversial, for example, idiopathic thrombocytic purpura. More recently, intriguing suggestions that H. pylori has protective effects in GERD and autoimmune diseases, such as asthma, have gained momentum. Therefore, we consider the basis for these suggestions and discuss the potential impact for future therapeutic rationales.

scholarly journals Association of dupA, iceA, homB Genes of Helicobacter pylori with Gastritis, Peptic Ulcer Disease and Gastric Cancer

2020 ◽  
pp. 1-6
Author(s):  
Muhammad Akram Bajwa ◽  
Muhammad Idrees ◽  
Prem Kumar Maheshwari
Keyword(s):  
Gastric Cancer ◽  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Analytical Study ◽  
Pcr Primers ◽  
Cross Sectional ◽  
Ulcer Disease ◽  
Gastric Biopsies ◽  
H Pylori

Objective: To determine the association of dupA, iceA, homB genes of Helicobacter pylori with gastro-duodenal diseases such as gastritis, peptic ulcer disease PUD and gastric cancer. Materials and Methods: This cross-sectional analytical study was conducted at Gastroenterology Department, Shaikh Zayed Hospital Lahore. Patients with gastro-duodenal diseases and positive H. pylori were included. Gastric biopsies were taken from fundus, body and antrum. H. pylori DNA were removed utilizing Gentra DNA extraction Kit (Life Technologies, USA) as per the technique and Qualitative PCR for the recognition of H. Pylori DNA. The PCR primers sets were designed for the specific detection of dupA, iceA and homB genes of H. pylori. All the data was recorded in proforma and analyzed by SPSS version 20. Results: Mean age of the cases was 41.22+8.04 years. Males were more affected 118(60.2%). HomB was the most common 76(38.8%) followed by dupA and iceA 28.6% and 24.5% respectively. Peptic ulcer disease and gastritis were higher among patients having dup A and iceA positive strains as compared to homB gene patients, while gastric cancer was significantly higher among HomB gene infected patients, p-values were quite significant. Conclusion: It was concluded that homB gene was most frequent in H. pylori infected population. Peptic ulcer disease and gastritis are markedly associated with dupA and iceA genes, while homB gene infected patients are at high risk of gastric cancer.

scholarly journals Identification of Markers for Helicobacter pylori Strains Isolated from Children with Peptic Ulcer Disease by Suppressive Subtractive Hybridization

2006 ◽  
Vol 74 (7) ◽  
pp. 4064-4074 ◽  
Author(s):  
Mónica Oleastro ◽  
Lurdes Monteiro ◽  
Philippe Lehours ◽  
Francis Mégraud ◽  
Armelle Ménard
Keyword(s):  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Subtractive Hybridization ◽  
Suppressive Subtractive Hybridization ◽  
Ulcer Disease ◽  
Lipopolysaccharide Biosynthesis ◽  
The Difference ◽  
H Pylori

ABSTRACT Peptic ulcer disease (PUD) occurs after a long-term Helicobacter pylori infection. However, the disease can develop earlier, and rare cases have been observed in children, suggesting that these H. pylori strains may be more virulent. We used suppressive subtractive hybridization for comparative genomics between H. pylori strains isolated from a 5-year-old child with duodenal ulcer and from a sex- and age-matched child with gastritis only. The prevalence of the 30 tester-specific subtracted sequences was determined on a collection of H. pylori strains from children (15 ulcers and 30 gastritis) and from adults (46 ulcers and 44 gastritis). Two of these sequences, jhp0562 (80.0% versus 33.3%, P = 0.008) and jhp0870 (80.0% versus 36.7%, P = 0.015), were highly associated with PUD in children and a third sequence, jhp0828, was less associated (40.0% versus 10.0%, P = 0.048). Among adult strains, none of the 30 sequences was associated with PUD. However, both jhp0562 and jhp0870 were less prevalent in adenocarcinoma strains than in PUD strains from children and adults, the difference being statistically significant for jhp0870. In conclusion, two H. pylori genes were identified as being strongly associated with PUD in children, and their putative roles as an outer membrane protein for jhp0870 and in lipopolysaccharide biosynthesis for jhp0562, suggest that they may be novel virulence factors of H. pylori.

scholarly journals Association of Helicobacter Pylori with Peptic Ulcer Perforation

2019 ◽  
Vol 2 (1) ◽  
pp. 4-10
Author(s):  
Sunit Agrawal ◽  
D Thakur ◽  
P Kafle ◽  
A Koirala ◽  
R K Sanjana ◽  
...  
Keyword(s):  
Risk Factors ◽  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Perforated Peptic Ulcer ◽  
Patch Repair ◽  
Peptic Ulcer Perforation ◽  
Ulcer Disease ◽  
Ulcer Perforation ◽  
H Pylori

Background: Helicobacter pylori is found in more than 90% cases of peptic ulcer. This study examines the possibility of association of Helicobacter pylori in perforated peptic ulcer disease and its relation to persisting ulcer as well as the influence of other risk factors; namely: smoking, alcohol, current non-steroidal anti inflammatory drugs (NSAIDs) and steroid use. Materials and Methods: In this prospective study, total of 50 cases of peptic ulcer perforation admitted in College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal were selected on the basis of the non-probability (purposive) sampling method. All patients who presented with suspected peptic ulcer perforation were included in the study and the perforations were repaired by Modified Graham’s Patch and were given triple therapy postoperatively. The age, sex, incidence, mode of presentation, precipitating factors, association with the risk factors and postoperative complications were all evaluated and compared. Results: Of 50 patients studied, the age ranged from 17 to 75 years, mean age being 40.1 years with the peak incidence in the 3rd and 5th decades of life showing a male dominance (92%). H. pylori was seen in ulcer edge biopsy in 29 patients (58%). Most common clinical presentation was pain abdomen, the most common signs of perforation were tenderness, rebound tenderness and absent bowel sounds. The mean duration of stay in hospital in H. pylori positive patients was 12.07±8.15 days as compared with 11.1±5.12 days in H. pylori negative patients. The incidence of peptic ulcer perforation was higher in the patients consuming alcohol (64%) than smokers (48%), followed by NSAIDs user(22%). 20% of the patients with delayed presentation developed complications postoperatively. Perforated peptic ulcer was repaired by Modified Graham’s Patch Repair, followed by anti H. pylori therapy in all of them. Conclusion: Peptic ulcer perforation is quite common among the patients with peptic ulcer disease with history of chronic smoking, alcoholism and analgesic intake, more commonly in males. There is association of H. pylori in 58% of patients with peptic ulcer perforation.

scholarly journals RECURRENCE RATE OF HELICOBACTER PYLORI IN PATIENTS WITH PEPTIC ULCER FIVE YEARS OR MORE AFTER SUCCESSFUL ERADICATION

2016 ◽  
Vol 53 (3) ◽  
pp. 152-155 ◽  
Author(s):  
Yuri Costa Farago FERNANDES ◽  
Gabriel da Rocha BONATTO ◽  
Mauro Willeman BONATTO
Keyword(s):  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Recurrence Rate ◽  
Early Recurrence ◽  
Peptic Ulcers ◽  
Ulcer Disease ◽  
Gastroduodenal Mucosa ◽  
H Pylori

ABSTRACT Background Infection with Helicobacter pylori is highly prevalent worldwide, especially in developing countries. Its presence in the gastroduodenal mucosa is related with development of peptic ulcer and other illnesses. The eradication of H. pylori improves mucosal histology in patients with peptic ulcers. Objective This study was aimed to verify if H. pylori recurrence occurs five years or more after confirmed eradication in patients with peptic ulcer. Moreover, we sought to determine the recurrence rate. Methods Retrospective and longitudinal, this study was based on a sample of 201 patients from western Paraná, Brazil. The patients were diagnosed with peptic ulcer disease, in the period of 1990-2000, and followed for five years or more after successful H. pylori eradication. Patients with early recurrence - prior to five years after eradication - were excluded from the sample. Results During an average follow-up of 8 years, 180 patients (89.55%) remained negative, and 21 (10.45%) became positive for H. pylori infection. New ulcers appeared in two-thirds of the patients with H. pylori recurrence. Conclusion The recurrence of H. pylori in patients with peptic ulcer can occur in the long-term - even if the infection had been successfully eradicated and the patients had remained free of recurrence in the first years of follow-up.

scholarly journals Arrest of chronic acid suppressant drug use after successful Helicobacter pylori eradication in patients with peptic ulcer disease: a six-month follow-up study

2001 ◽  
Vol 15 (7) ◽  
pp. 1047-1054 ◽  
Author(s):  
G. J. B. Hurenkamp ◽  
H. G. L. M. Grundmeijer ◽  
A. Van Der Ende ◽  
G. N. J. Tytgat ◽  
W. J. J. Assendelft ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Drug Use ◽  
Peptic Ulcer Disease ◽  
Helicobacter Pylori Eradication ◽  
Ulcer Disease ◽  
Follow Up Study
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