Tracking the Virulent Helicobacter pylori Strains Instead of Its Pan-Screening to Prevent Gastric Cancer

Gastric colonization by Helicobacter pylori is associated with the development of chronic gastroduodenal disorders, including atrophic gastritis, duodenal ulcer, and gastric cancer. Mainly over the last three decades, exemplary research efforts and clinical trials have been aimed at achieving the best formulation and treatment regimens for mass eradication of H. pylori. Reflecting on these efforts, we would like to pose the following questions: Is it mandatory to aim for eradication of all H. pylori strains or only specific strains thereof? What populations should be selected for antibiotic therapy? Until now, the screen-and-treat strategy has been the best recommendation by the guidelines for clinicians caring for patients from high-risk populations, but targeting the virulent strains of H. pylori had not been considered. However, updated guidelines based on renewed concepts to improve H. pylori treatment could help clinicians better manage their patients who suffer from gastric cancer. Importantly, preventing gastric cancer will not be feasible by the screen-and-test strategy alone. Here, we present a commentary proposing a renewed consideration of H. pylori screening and treatment and their potential impact on H. pylori eradication in anticipation of preventing gastric cancer.