Public health measures to eradicate H. pylori in the general population may prevent the occurrence of non-ulcer dyspepsia, peptic ulcer, and gastric cancer. However, they may, at the same time, increase the prevalence of gastroesophageal reflux disease (GERD).
Thus, Amnon Sonnenberg conducted a decision analysis, to quantify the counteracting influences of H. pylori and resolve the controversy about a public policy to eliminate H. pylori from the general population.
The findings of the study were published in the February issue of Helicobacter.
A compartment model was structured to analyze the jointly beneficial and adverse effects of H. pylori.
Gastric acid, H. pylori infection, and other pathophysiological mechanisms influence the occurrence of reflux disease, peptic ulcer, and dyspepsia. These in turn all contribute to the occurrence of upper abdominal symptoms.
Each influence was modeled as a separate compartment, with various connections to other compartments.
| A compartment model provides a powerful method to assess complex disease behavior.
| Helicobacter |
The simulation was then carried out on an electronic spreadsheet.
A decision in favor or against eradication of all H. pylori depends primarily on the relative contribution of reflux disease versus peptic ulcer and dyspepsia, to upper abdominal symptoms in the general population.
It was found that, if reflux-related symptoms contribute twice more than peptic ulcer plus dyspepsia to the overall occurrence of abdominal symptoms, a strategy to eradicate H. pylori would actually lower, rather than raise, public health.
Below this threshold, such a strategy may improve general well being.
In the individual patient infected with H. pylori, it was found to remain beneficial to eradicate H. pylori, irrespective of the symptoms' nature.
Sonnenberg comments, "It is advisable to treat H. pylori infection in the individual patient who comes to medical attention.
"However, a general policy directed towards complete elimination of H. pylori from the population would not be beneficial."
"A compartment model provides a simple yet powerful method to assess complex disease behavior," it was concluded.