However, it is not yet indicated to eradicate all East-Asian cagA-positive cases, as most H. pylori infections in this region are the East Asian type. For instance, in the authors’ recent study, 94% of H. pylori infections among Korean subjects were of the East-Asian cagA type.57 First-degree relatives

of gastric cancer patients might be at an increased risk of developing gastric cancer, as judged by a significantly higher prevalence of H. pylori, Roxadustat chronic atrophic gastritis, and intestinal metaplasia.58,59 Compared with healthy controls, first-degree relatives of patients with gastric cancer had a higher prevalence of hypochlorhydria, and of gastric atrophy than patients with non-ulcer dyspepsia matched for H. pylori prevalence.60 Notably, among the relatives of cancer patients, the prevalence of atrophy and hypochlorhydria is increased only in those with H. pylori infection. Further, it is greater in relatives of patients with familial cancer than among relatives of sporadic

cancer index patients, and increases with age. Eradication of H. pylori resolved the gastric inflammation, hypochlorhydria and atrophy in half of the subjects.60 In subjects with family history of gastric cancer, H. pylori detection and prophylactic eradication of the infection should be offered, especially when the subject is less than 40 years old. Siblings of patients who develop gastric cancer before 40 years of age have a higher H. pylori infection rate and higher prevalence of intestinal CHIR-99021 nmr metaplasia in the body, and show a higher multivariate-adjusted odds ratio (OR) for gastric Selleckchem Belinostat cancer (OR 3.60).61 Because gastric cancer

in patients younger than 40 years old is closely associated with H. pylori infection rather than genetic causes, eradication may be adopted as a strategy for the prevention or early detection of cancer in young subjects.62 To date, it is not well defined whether to treat all H. pylori-positive patients taking a PPI and/or antiplatelet agents. There is evidence in patients taking NSAIDs long term in favor of H. pylori eradication,63 but there is no objective clinical data on cyclooxygenase-2 inhibitors and aspirin. Despite the conflicting opinions, it is reasonable to recommend screening for H. pylori eradication in subjects taking antiplatelet agents since the presence of H. pylori infection aggravates mucosal damage.63 Notably, the opinions and clinical practice patterns for the management of anticoagulation and antiplatelet medications differ significantly between Eastern and Western endoscopists.64 Since there is a tendency among Eastern endoscopists to think that Asians are more prone to bleeding than Caucasians, H. pylori eradication might be considered more seriously in East Asians to prevent drug-induced ulcers. PPI may accelerate the development of atrophic gastritis when H. pylori is present,65 and thus H. pylori may need to be treated before long-term PPI therapy.