EUROHELICAN - Accelerating gastric cancer reduction in Europe through Helicobacter pylori eradication

Gastric cancer remains a major challenge to public health on a global scale. In Europe, there is a significant geographical variation in Helicobacter pylori (H. pylori) related gastric cancer incidence with the regions of Central and Eastern Europe having the highest burden. H. pylori is the main cause of infection-related cancer worldwide, responsible for 89% of non-cardia gastric cancers. Considering its absolute burden and persisting disparities, gastric cancer is a logical target for urgent action on prevention.

Population-based H. pylori test- and treat has therefore been proposed as a strategy for gastric cancer prevention supported by the latest European and International recommendations and Europe’s Beating Cancer Plan 2023–2033.

However, no country has yet implemented the strategy for gastric cancer prevention. Some of this inaction may reflect lingering doubts about the feasibility and acceptability of such a strategy at the population level and uncertainty about possible short- and long-term adverse consequences of mass antibiotic treatment. In addition, there is no available guidance on how to best implement it and how to evaluate the programmes for successful implementation. Therefore, the aim of this project is to fill those gaps.

Project added value

The results from this project will help policy makers to incorporate the population-based H. pylori test- and treat strategy into their healthcare priorities for gastric cancer prevention while balancing its effectiveness, feasibility and acceptability with its short- and long-term potential adverse effects. Consequently, this will facilitate acceleration of gastric cancer reduction in Europe and prevent important loss of life and productivity caused by this preventable malignancy.

Since Slovenia is one of the European countries with a high incidence and mortality from gastric cancer, the results of the project will be directly useful for planning measures in Slovenia.

The results of both studies will add to the scientific findings on the effects and feasibility of the H. pylori test- and treat strategy and contribute to the evidence in this field.

Project duration: 1.11.2022 – 30.4.2025

Leading partner: National Institute of Public Health (NIJZ)

Project partners: Community Healthcare Center dr. Adolf Drolc Maribor (ZD MB), University of Latvia Institute of Clinical and Preventive Medicine (LU), The International Agency for Research on Cancer of the World Health Organization IARC/(WHO), Nantes University Hospital (NANTES)

Funding:  European Health and Digital Executive Agency (HADEA) under the powers delegated by the European Commission

The general objective of the EUROHELICAN project is to assess the feasibility of population-based H. pylori test- and treat strategy for gastric cancer prevention in Europe. The EUROHELICAN project aims to contribute to the improvement and fostering of health in the European Union by contributing to Europe’s Beating Cancer Plan’s objective to prevent gastric cancers caused by H. pylori infections.

EUROHELICAN’s objectives include:

1) demonstration of feasibility and acceptability of the proposed population-based H. pylori test- and treat strategy in a community health service setting,

2) evaluation of potential long-term adverse effects of the proposed strategy and

3) establishment of a set of minimum standards for the implementation and impact evaluation of the strategy that can be adopted in Europe and globally.

EUROHELICAN is organized in a total of six Work Packages with three of them representing the core tasks on the contents of the project:

Work Package 4: Gastric cancer prevention through H. pylori test- and treat strategy in Slovenia

(Lead Beneficiary: NIJZ)

Implementation of a population-based H. pylori test- and treat program in a young adult population in Slovenia to assess its program processes, feasibility, acceptability and effectiveness.

A total of 2,000 men and women aged between 30 and 34 will be recruited from various municipalities in the framework of a larger local primary care Community Health Centre Maribor as part of their preventive medical check-up for the general population for common risk factors. 

Study participants will be interviewed by a health professional and they will undergo a test for H. pylori infection with IgG serology. Those who will have positive antibodies will undergo a urea breath test (UDT). All those who will test positive for the infection will receive 14-day antibiotic treatment. Eradication rate will be controlled with UDT one month after the end of the treatment.

We expect to observe at least 30% participation in the program, 80% compliance with the 14-day H. pylori treatment, 85% H. pylori eradication rate and around 30% of mostly mild adverse events from the treatment of which none are serious adverse events.


Work Package 5: Long-term evaluation of the potential adverse effects of test- and treat strategy in Latvia

(Lead Beneficiary: LU)

We will evaluate the long-term effects of the strategy in middle-aged Latvians who were included in the GISTAR study an average of 10 years ago. The long-term effects of the H. pylori eradication will be investigated, by comparing the H. pylori positive groups having undergone H. pylori eradication or not at baseline of the GISTAR study. The third group will be residents included in the GISTAR survey, who were H. pylori negative at the time of inclusion.

The study subjects that were enrolled from 2013 (aged 40–64 at enrolment) will be invited to participate. The participants will be in an age range of 44-74 years. Five years will be the average follow-up period since the recruitment. Altogether 2,000 men and women will be recruited.


Work Package 6: Development of IARC Working Group Report on the implementation and evaluation of population-based H. pylori test- and treat strategy through an expert Working Group Meeting

Lead Beneficiary: International Agency for Research Cancer (IARC)

Based on the collected results, IARC will organize a meeting of an expert working group, which will have to prepare the guidelines for the implementation of the H. pylori test- and treat strategy with the aim of preventing gastric cancer in Europe and in the world.


In addition to the substantive core Work Packages described above, the EUROHELICAN project also has three Work Packages that ensure proper project management, namely:


Work Package 1: Coordination

Lead Beneficiary: NIJZ

As part of Work Package 1, management of the entire consortium, reporting to financiers on the progress of the project, preparation of substantive and financial reports, coordination and orientation at the strategic level of the project is carried out.


Work Package 2: Dissemination

Lead Beneficiary: NIJZ

NIJZ will disseminate the results of the project in both local and international contexts through a diverse range of communications tools, aimed at both the general public and professional audiences. A campaign at local level within Slovenia and Latvia will be carry out to recruit participants for the study and promote H. pylori screening for gastric cancer prevention.


Work Package 3: Evaluation

Lead Beneficiary: Nantes University Hospital

The outputs and results of the projects will be evaluated in line with the planned objectives and defined indicators. More specifically: evaluation of the study protocols, proposed for the field studies included in WP 4 and WP 5; following the progression of both field studies with providing a status update at interim, and discussing of possible problems, proposal of solutions and final evaluation of the results with respect to the initial objectives, practical implementation and further perspectives.

All materials will be published on the website.



Disclaimers: Funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or European Health and Digital Executive Agency (HADEA). Neither the European Union nor the granting authority can be held responsible for them.

Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer/World Health Organization.