The 14C-Urea breath test is an inexpensive, extremely safe and effective method of identifying patients with Helicobacter pylori. As clinicians, we have been struck by the high incidence of Helicobacter pylori infection and gastric cancer in relatively young Asian individuals at our institution. Although Asians make up 2% of our hospital inpatient population, they constitute 25% of the patients seen with gastric cancer. We have become a referral center for several Asian born physicians who practice in our catchment area. We plan to offer Helicobacter pylori screening using the 14C-Urea breath test through their offices. The nature of the 14C-Urea breath test allows it to be administered in the community and a breath sample obtained and transported to the laboratory. After identifying Helicobacter pylori positive individuals, endoscopy will be performed in order to identify patients with intestinal metaplasia. Patients will be treated with four drug regimen with a 95%+efficacy. Three months after treatment, patients will undergo repeat breath testing to determine or whether or not Helicobacter pylori has been eradicated. Individuals with persistent infection will be retreated with an alternate regimen. At one year, subjects will undergo follow-up endoscopy to determine whether or not eradication of Helicobacter pylori has influenced gastric histology. We believe that it is extremely important to document whether or not intestinal metaplasia regresses after Helicobacter pylori is eliminated. Whether or not this happens is unknown. However, a parallel observation may be applicable in the eradication of Helicobacter pylori can reverse low grade gastric mucosa associated lymphoma (MALT).
