We read with interest the article by Swinkels and colleagues1 in which a modified Delphi consensus was used to select treatable conditions for immigrants to Canada for future guideline development. We were surprised that Helicobacter pylori was not among the infectious diseases identified as high-priority conditions for guideline development. Helicobacter pylori causes a chronic infection associated with peptic ulcer disease and is the most significant risk factor for the development of gastric cancer, the second leading cause of cancer death worldwide.2 Eradication of H. pylori decreases the risk of peptic ulcer disease and, if initiated prior to development of precancerous changes, may prevent gastric cancer.2
Although the prevalence of H. pylori is decreasing in Canada, in recent immigrants from places such as Africa, the Middle East, Latin America and Asia the prevalence of infection remains high.3 In a study of African immigrants in Australia, H. pylori infection was detected in 60% of participants and was the most common infection. In contrast, Hepatitis B, which was identified as a priority by Swinkels and colleagues, was present in 19% of individuals.4 Many areas such as Asia and South America are high-risk regions for gastric cancer.3 Asian-Pacific guidelines on gastric cancer prevention recommend screening for and eradicating H. pylori in high-risk populations.5 Importantly, Canadian guidelines also recommend screening for and eradicating H. pylori in immigrant populations where the incidence of gastric cancer is high.6
The Canadian Helicobacter Study Group recently convened a meeting addressing at-risk populations for infection in Canada. In addition to native Canadians, data regarding recent immigrants were extensively reviewed and indicated that immigrant populations were at increased risk.3 Helicobacter pylori should be among the infectious diseases selected as high priority for Canadian immigrant guideline development because the majority of immigrants come from high-prevalence regions, which also have an increased risk for gastric cancer. Furthermore, screening tools as well as inexpensive and effective interventions exist to eliminate infection, which could prevent the development of disease complications.
References
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