Topics in Helicobacter pylori infection: focus on a 'search-and-treat' strategy for ulcer disease.

Several new and interesting issues regarding Helicobacter infection are discussed. Test-and-treat strategies in young dyspeptics will do little to reduce the burden of ulcer disease. The prevalence of Helicobacter infection in young people is low and still declining; the incidence of ulcer disease is therefore low. Ulcer disease has a high prevalence and most cases occur in older people. There is a large pool of people who have suffered from a documented peptic ulcer in the past and most are still intermittently symptomatic. If we are to decrease the prevalence of ulcer disease we ought to promote case finding. Only 'search-and-treat' strategies will help to eliminate ulcer disease. These can focus on patients with an ulcer history or on populations that regularly use acid suppressants. Such strategies, of which several examples are discussed, are cost-effective and lead to improved health in the target population. We also discuss the use of serology as a follow-up instrument after anti-Helicobacter therapy and discuss issues regarding Helicobacter therapy in relation to antimicrobial resistance in The Netherlands.