351 Population Based 'screen And Treat H. Pylori Gastritis' Project In Primary Health Care In Vammala, Finland

Author(s): 
SALOMAA Anniina (1,2), KOSUNEN Timo U (2), AROMAA Arpo (3), KNEKT Paul (3), KLAUKKA Timo (4), HEINONEN Olli P (2), REHNBERG-LAIHO Leena (2), RAUTELIN Hilpi (2).
(1) Vammala Health Centre, Vammala
(2) University of Helsinki,
(3) National Public Health Institute,
(4) Social Insurance Institution, Helsinki, Finland
Text: 
Background and Aim:
Helicobacter pylori seroprevalence rate in the adult population of Vammala decreased from 51 to 34% from 1973 to 1994, before antibiotics were used to treat gastritis in this semi urban community. To speed up this natural decline we started a population based, voluntary 'screen-and-treat' program in 1996 as a primary health care routine. The program was tested in 1994 in a pilot study: 87% of the invited 878 subjects participated. In this group the seroprevalence rate decreased from 39 to 21%.
Materials and Methods:
All subjects aged 15 to 40 years living in Vammala (over 4400 subjects) were invited to give a blood sample for H. pylori IgG and IgA antibody EIA-tests. All antibody positive subjects were offered antimicrobial therapy (first choice: amoxicillin 500 mg x 4, metronidazole 400 mg x 3 and lansoprazole 30 mg x 2 for 7 days).
Results: 3328 (75%) subjects participated and 408 of them (12%) were antibody positive. 82% of the 316 subjects treated and followed up for 6 months showed a diagnostic fall of antibody titres (by at least 40%). The seroprevalence rate of this cohort improved to 4%.
Conclusions:
The primary health care system of Finland provides good possibilities to organize large-scale screening and treating gastritis programs. Serological assays with a specificity and sensitivity exceeding 95% provide a reliable, easy and cheap method to diagnose H. pylori infection and follow-up the success of treatment. In the cohort studied in Vammala the H. pylori seroprevalence rate decreased during such a program from 12 to 4%.
Literature: 
351 POPULATION BASED 'SCREEN AND TREAT H. PYLORI GASTRITIS' PROJECT IN PRIMARY HEALTH CARE IN VAMMALA, FINLAND