On July 25 last year, an elderly man, a relative of the dean of our hospital, had normal physical examination indicators and normal tumor markers. Only Helicobacter pylori was positive. The elderly did not feel any discomfort. However, unexpectedly, gastroscopy is an advanced gastric cancer!
On August 19 of the same year, we also found a case of early gastric cancer in a 32-year-old woman who was a second-born mother. She has been suffering from indigestion, constipation and other problems, and she hasn't paid too much attention to it, and has been dragging it all the time. I came to the hospital for examination only a few days ago, and the carbon 14 breath was positive +++. The gastroscope found suspicious lesions on the anterior wall of the gastric body, and the pathological results showed gastric adenocarcinoma. Fortunately, it is an early cancer. After evaluation, it is intramucosal carcinoma, well-differentiated, without lymphatic and vascular invasion, and the lesion is about 1 cm, which is in line with the indications for endoscopic treatment. On the 22nd, the ESD operation was successfully implemented and the operation was perfect.

In fact, both patients had been found to have Helicobacter pylori infection during routine examinations a few years ago. At the time, they were asymptomatic, so they ignored them. If it can be eradicated at that time, it may be possible to avoid such serious consequences and risks, or at least not to develop so quickly.

Regarding whether adults who are Hp positive but have no symptoms need to be eradicated, domestic experts have always had two opinions:One believes that as long as there are no counter-factors, it is recommended to eradicate the disease; the other believes that people who have no symptoms and are not at high risk do not need to be eradicated.

The International Agency for Research on Cancer under the WHO classifies carcinogens into 4 categories:Category 1 (definitely), Category 2a (probably), Category 2b (probable), Category 3 (lack of evidence) and Category 4 (not carcinogenic).Helicobacter pylori infection is classified as a type 1 carcinogen of gastric cancer, which means it will definitely increase the risk of gastric cancer. Almost all intestinal-type gastric cancers are related to it. Therefore, the 2018 Houston Consensus and the 2015 Kyoto Global Consensus both recommend:Treat all infected people, unless he has countermeasures.

On April 19, 2020, my country issued the "Expert Consensus Opinions on Helicobacter Pylori Eradication and Gastric Cancer Prevention and Control in China (2019, Shanghai)". The "Consensus" states that:

1. Helicobacter pylori is not a probiotic, but an infectious disease, eradication is the most important controllable means to prevent gastric cancer;
2. According to Japan’s experience, the eradication will benefit the most from the age of 18-40;
3. Eradication of superficial gastritis or asymptomatic stage will benefit the most, and it can prevent intestinal gastric cancer almost 100%;
4. The benefits of eradicating Hp outweigh the disadvantages; there is no direct evidence that it is positively related to certain diseases;
5. In the selection of eradication programs, the previous standard triple therapy is abandoned, and quadruple therapy containing bismuth is recommended;
6. It is recommended that all adults without countermeasures should be checked and eradicated.

Academician Li Zhaoshen, Director of the National Center for Clinical Research on Digestive Diseases, said:"No matter when, Helicobacter pylori (Hp) infection should be eradicated, regardless of age or time, as long as the test is positive, the earlier the eradication, the greater the benefit."

In my country’s "Fifth National Consensus Report on the Treatment of Helicobacter Pylori Infection", it is believed that The best time to eradicate Hp should be before the occurrence of gastric mucosal atrophy and intestinal metaplasia.

The infection rate of Helicobacter pylori in my country is as high as 40%-60%, which means that almost one in two people is infected, and the infection rate of children and adolescents is also as high as 20%-30%.
As early as 1994, Hp was listed as a class I carcinogen of gastric cancer. Since Hp can be eradicated clinically, Hp infection is the most important and controllable risk factor in gastric cancer prevention.
At the same time, eradication of Hp can significantly reduce the risk of chronic gastritis, gastric ulcer recurrence and duodenal ulcer recurrence.
Academician Li Zhaoshen also said: "Stomach cancer is actually a process from inflammation to cancer. To a large extent, inflammation comes from Hp infection.At the stage of intestinal metaplasia, I think it cannot be reversed. There are many controllable factors in this process, and Hp infection is one of them. "

The American pathologist, Professor Correa, proposed the intestinal gastric cancer pattern as early as 1975:Normal gastric mucosa→chronic superficial gastritis→chronic atrophic gastritis→intestinal metaplasia→dysplasia→gastric cancer.

And eradication of Hp before the occurrence of atrophy and intestinal metaplasia can almost 100% prevent the occurrence of intestinal gastric cancer! Even after the occurrence of intestinal metaplasia, it can help the repair of gastric mucosa, and at least it can maintain the status quo without developing gastric cancer!

Japan used to be the country with the highest incidence and death rate of gastric cancer in the world; they have implemented the strategy of eradicating H. pylori by all people in 2012. They have to check and eradicate H. pylori from the age of 12, and have popularized gastroscopy. In addition, there are few residents. Eat high salt, stale food, etc.
This has caused the double rate of gastric cancer in Japan to continue to decline for 60 consecutive years! my country currently wears the world's No. 1 hat on its head. 498,000 people die from gastric cancer every year, and there is a trend of getting younger! The main reason lies in the lack of attention to the examination and treatment of Helicobacter pylori. Academician Li Zhaoshen said: "We admit that we cannot completely prevent the occurrence of gastric cancer. We must also admit that we have neglected the early diagnosis and treatment of gastric cancer. We firmly believe that,

The fight against gastric cancer begins with the eradication of Helicobacter pylori. "In other words,Eradication of Hp is the most important controllable factor in controlling gastric cancer.

In short: Only by eradicating Helicobacter pylori can we effectively prevent gastric cancer! As long as they are positive adults over the age of 14 to under 75, there are no counter-factors, and eradication is required and recommended. Children under the age of 14, pregnant women, breastfeeding women, and elderly people are not recommended for testing and treatment unless necessary; the following populations are recommended to be tested and eradicated as soon as possible:

• Age is greater than or equal to 40 years old;

• People in areas with a high incidence of gastric cancer;

• Helicobacter pylori infection;

• Previously suffering from chronic atrophic gastritis, gastric ulcers, gastric polyps, postoperative remnant stomach, hypertrophic gastritis, pernicious anemia and other gastric precancerous diseases;

• First-degree relatives of gastric cancer patients;

• There are other high-risk factors for gastric cancer (high salt, salted diet, smoking, heavy drinking, etc.).