Does a 15-year-old with H. pylori antibodies and a family history of stomach cancer require annual endoscopies to screen for stomach cancer?

H. Pylori Antibodies and Gastric Cancer Screening in a 15-Year-Old with Family History

Your 15-year-old relative does NOT need annual endoscopies at this time, but should undergo H. pylori eradication treatment immediately and have a single baseline endoscopy performed once they reach their mid-20s to assess for any precancerous changes. 1

Immediate Management: H. Pylori Eradication

• H. pylori eradication is essential and serves as primary prevention for gastric cancer, particularly when performed before the development of gastric precancerous changes 1
• The American Gastroenterological Association recommends opportunistic screening and treatment for H. pylori in household members of individuals who test positive (so-called "familial-based testing"), which applies directly to your situation given the family member's active infection 1
• Evidence from long-term studies shows that H. pylori eradication in individuals without gastric precancer at baseline reduces gastric cancer risk by 63%, compared to only 43% reduction when considering all individuals regardless of histology 1
• The greatest benefit of H. pylori eradication occurs before age 40 and before the development of atrophic gastritis or intestinal metaplasia 1

Why Annual Endoscopies Are NOT Indicated Now

• The presence of H. pylori antibodies alone does not warrant endoscopic surveillance in a 15-year-old, even with a first-degree relative with gastric cancer 1
• Current AGA guidelines (2025) recommend endoscopic screening only for individuals at increased risk who are of appropriate age, typically starting in the mid-20s to 30s for those with significant family history 1
• Endoscopic surveillance is reserved for individuals with confirmed gastric atrophy, intestinal metaplasia, or dysplasia on histology—not for H. pylori seropositivity alone 1

When to Consider Initial Screening Endoscopy

A single baseline screening endoscopy should be considered when your relative reaches their mid-20s (approximately age 25-30), given the combination of:

• First-degree family history of gastric cancer 1
• Documented H. pylori exposure (antibody positive) 1
• The fact that gastric cancer risk increases substantially after age 50, but precancerous changes develop decades earlier 1

What the Baseline Endoscopy Should Include

If/when a screening endoscopy is performed, it must include 1:

• Systematic biopsy protocol with minimum 5 biopsies: samples from antrum/incisura and corpus placed in separately labeled jars
• Assessment for gastric atrophy, intestinal metaplasia, or dysplasia
• Documentation of any residual H. pylori infection

Subsequent Management Based on Baseline Findings

If the baseline endoscopy shows NO atrophy, intestinal metaplasia, or dysplasia:

• Ongoing screening should be considered every 3-5 years given the family history of gastric cancer 1
• The optimal intervals are not well-defined, but this represents a reasonable risk-stratified approach 1

If the baseline endoscopy identifies intestinal metaplasia or atrophy:

• Surveillance endoscopy every 3 years is recommended, particularly with family history 1
• Shorter intervals may be advisable if severe or extensive changes are found 1

Important Caveats

• H. pylori antibodies indicate exposure but do not confirm active infection—your relative should undergo testing for active infection (stool antigen or urea breath test) and receive eradication therapy if positive 1
• Even after successful H. pylori eradication, individuals with established precancerous changes remain at risk and require surveillance 1
• The 38-year-old family member's H. pylori-associated cancer does elevate your 15-year-old's baseline risk, making them a candidate for risk-stratified screening—but not at age 15 1
• Annual endoscopy would only be considered if severe dysplasia or extensive intestinal metaplasia were found on a baseline examination, which is extremely unlikely in a 15-year-old 1

Practical Algorithm

1. Now (age 15): Confirm active H. pylori infection and eradicate if present 1
2. Age 25-30: Single baseline screening endoscopy with systematic biopsies 1
3. If baseline normal: Repeat endoscopy every 3-5 years given family history 1
4. If baseline shows intestinal metaplasia/atrophy: Surveillance every 3 years 1
5. If dysplasia found: Refer to expert center; surveillance intervals 6-12 months depending on grade 1