Unité d’hépatogastroentérologie, hôpital Hôtel-Dieu de Paris, 1, place du Parvis-de-Notre-Dame, 75181 Paris cedex 04, France
The systematic screening of H. pylori to prevent gastric cancer is not yet justified because the incidence of gastric cancer appears to decrease under the influence of environmental and alimentary factors. Targeted screening of premalignant lesions in infected patients is not yet feasible in practice. A better endoscopic recognition of premalignant lesions in the course every upper endoscopy, particularly with the help of optical magnifying endoscopes, could open the way for this screening in the future. Meanwhile, systematic biopsies of the antrum and corpus must be recommended, especially in patients over 40 years. Diffuse atrophy with intestinal metaplasia in the corpus is an indication for periodic endoscopy, although the screening interval has not been defined. A 3-year periodicity has been proposed. Non-invasive tests identifying at risk patients could become available in forthcoming years.