S3186 Screening and Eradication of Helicobacter pylori in a New York Community: Early Results From a Prospective Cohort

Introduction: Helicobacter pylori (HP) infection is a major risk factor for gastric cancer (GC), though infected individuals are often asymptomatic. Experts have proposed population-wide HP screening and eradication for GC prevention, but this strategy remains untested in the United States. We conducted an ongoing prospective “screen-and-treat” study in a New York community to assess HP prevalence, risk factors, and the utility of a novel serologic point-of-care test (nPOCT) that detects cytotoxin-associated gene A (CagA) and flagellar capping protein (FliD) antibodies for screening asymptomatic individuals. Methods: Adults ≥18 years were invited to participate at primary care clinics in Brooklyn, NY. Demographics, history, and dyspepsia were assessed via questionnaires. All patients were tested with nPOCT, with positive results indicated by antibodies against CagA and/or FliD. All patients were ordered a stool antigen test (SAT) regardless of nPOCT results. Patients with positive SAT were offered treatment. Variables were compared with test results using Fisher's exact test. The test characteristics of nPOCT were compared with SAT. Results: We analyzed data from patients enrolled from August 2024 to April 2025. The enrollment rate was 58%. Of the 133 patients enrolled, 51% were Hispanic/Latino, 23% Black, and 8% South Asian. Sixty-three percent were first-generation immigrants. Thirty-six percent were seropositive for HP antibodies, which was associated with generational status (P = 0.01). Of the 65 patients who completed SAT, 31% tested positive for active infection on SAT. Most were 18-39 years old. Sixty-five percent were first-generation immigrants. Forty percent of HP-positive patients had dyspepsia, with epigastric burning the most frequent symptom. There was no personal or family history of HP or GC in almost all HP-positive patients. Fifty percent of patients received quadruple therapy, and eradication was confirmed in forty percent by repeat SAT. Compared to SAT, the nPOCT demonstrated a negative predictive value (NPV) of 89% for ruling out active HP infection among asymptomatic patients. Conclusion: Our preliminary findings reveal >30% prevalence of HP in our urban clinic population. Screening of first-generation immigrants from high-endemic regions should be prioritized. The nPOCT, with a NPV of 89%, shows potential as a rapid screening tool in a 2-step testing strategy: positive nPOCT results can be confirmed with SAT, while negative results may not require further testing. Ongoing enrollment will help confirm these findings and support early HP detection to prevent GC.