Test for Helicobacter pylori, and eradicate it if positive

High value
Evidence A
Buys life
Costs a little
Takes minutes
Some willpower

In plain words

In the Linqu, Shandong trial, followed for 22 years, people whose H. pylori was eradicated were about half as likely to get stomach cancer later, and about 40% less likely to die of it. The test costs one or two hundred CNY, and eradication means two weeks of pills.

Cost: A carbon-13 or carbon-14 breath test costs 100 to 200 CNY. Eradication takes four drugs together, and two weeks of drugs cost 200 to 500 CNY. The hard part is taking them on schedule for the full two weeks.
What you get: The randomized Linqu, Shandong trial followed people for 22 years. People who had H. pylori eradication treatment had about half the risk of stomach cancer (OR 0.48; 95% CI 0.32 to 0.71, the plausible range). Their risk of dying from stomach cancer was about 38% lower (HR 0.62, 95% CI 0.39 to 0.99).
Notes: After eradication you can be infected again, so test and treat the people you live with at the same time. The people in this trial were residents of an area with a high rate of stomach cancer. For people in low-rate areas, the benefit they actually get will be much smaller.
Evidence grade: A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.
Sources: Li WQ 等 (2019). Effects of Helicobacter pylori treatment and vitamin and garlic supplementation on gastric cancer incidence and mortality: follow-up of a randomized intervention trial. BMJ. https://doi.org/10.1136/bmj.l5016

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Translated from the Chinese original. Original book, section 1, tip 23. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer