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Government study calls for national H. pylori screening

General practice screening of all 40-year-olds for Helicobacter pylori infection is the most cost-effective way of averting deaths from subsequent peptic ulcer disease and gastric cancer, according to Government research.

The NHS health technology appraisal advocates a one-off general practice campaign for all 40- to 49-year-olds, followed by routine screening for new cases at age 40. It would mean screening half a million patients a year at an annual cost of £18 million.

The findings will inform

National Institute for Clinical Excellence guidance on dyspepsia due next year.

The proposed serology screening programme would lead to treatment for an extra 5.4 million patients, preventing 9,372 gastric cancer and 6,891 ulcer deaths to age 75, said researchers at the University of Southampton.

They concluded: 'Screening at age 40 might be the most pragmatic policy, balancing cost-effectiveness and the feasibility of screening. A national H. pylori screening programme of prevalent 40- to 49-year-olds and incident 40-year-olds would significantly reduce the incidence of peptic ulcers and gastric cancer at a relatively low cost to the NHS.'

Dr Richard Stevens, chair of the primary care society for gastroenterology and a GP in Oxford, supported a general practice-based screening programme. But he added: 'They need to sell this to GPs, who are actually going to do the work. A screening campaign with call-recall follow-up and chasing results ­ that's quite a considerable workload.'

The study compared predicted costs of national screening at age 20, 30, 40 or 50 plus a one-off campaign in patients between various ages and 49 years with opportunistic testing and treatment in patients with known dyspepsia.

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