Grant Number:	1R01CA311106-01 Interpret this number
Primary Investigator:	Thrift, Aaron
Organization:	Baylor College Of Medicine
Project Title:	Family-Based Helicobacter Pylori Infection Control and Management Strategy for Cost-Effective Prevention of Gastric Cancer
Fiscal Year:	2026

Project Summary/Abstract Helicobacter pylori infection is an established class 1 carcinogen that is responsible for approximately 90% of all non-cardia (distal) gastric cancers worldwide. It has been clearly documented in randomized controlled trials that H. pylori eradication is associated with a considerable reduction in the risk of developing gastric cancer. However, in the U.S., H. pylori screening for gastric cancer prevention is neither recommended nor cost-effective in the general population because of the low overall prevalence of H. pylori and gastric cancer in the general population. Instead, the predominant method of testing for H. pylori infection in the U.S. is ‘test-and-treat’ (symptom-based testing in clinical settings); however, this symptom-based testing strategy overlooks many silent H. pylori cases, and many individuals in the population remain unknowingly at risk for gastric cancer. Thus, alternative approaches of H. pylori testing and eradication are needed. Recently, the notion of ‘family-based testing’ (i.e., targeted testing of family members of H. pylori positive cases identified by symptom-based testing in clinical settings) has been introduced as a practical alternative strategy. Most cases of H. pylori are thought to be acquired during childhood related to fecal-oral or oral-oral routes of transmission among families. While clinical practice guidance from two GI societies in the U.S. suggest considering screening for H. pylori in adult household members of individuals positive for H. pylori, this guidance is based solely on expert opinion. No studies in the U.S. have investigated family-based infection rates, risk factors, and patterns of transmission and antibiotic resistance. Thus, no direct U.S. evidence exists, and hence there is no systematic implementation strategy for U.S. healthcare settings. The goal of this study is to develop and evaluate a family-based cost-effective approach for control of gastric cancer through screening for and eradication of H. pylori. Our proposed study will address the barriers to implementation of a family-based approach (testing and treatment) in the U.S., including a lack of basic information on prevalence and predictors of H. pylori infection among families (our Aim 1) and uncertainty around antibiotic susceptibility patterns in family members and its impact on the effectiveness of tailored therapy in families (our Aim 2). By building a comprehensive mathematical model of the entire natural history and clinical course of illness attributable to H. pylori, including intrafamilial transmission, we will provide a framework for examining the benefits and harms of different gastric cancer prevention measures (our Aim 3) for the U.S. Together, we will provide novel and actionable information on which combination of H. pylori testing and eradication strategies may be cost-effective in the U.S. for primary prevention of gastric cancer.





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