A few days ago, a father and son came to the clinic, and as soon as the father entered the clinic, he said, “Doctor, this is my son, he is 17 years old, didn’t you say before that when my son is older he must be tested for H. pylori, he always has stomach pains lately, so I brought him here, why don’t you prescribe a breath test for him first, I will let him check it first.” I asked the child, “What time do you tend to have stomach pains?” The child said he always had pains at 9:00 or 10:00 a.m. and 3:00 or 4:00 p.m. In the last few days, he also had frequent stomach pains at night, and he couldn’t sleep well at night. The child’s father immediately said, “He always has trouble sleeping at night lately, and he takes sleeping pills, and he has stolen a lot of my Daxil (a mucosal protector for stomach problems).” This symptom, which in medical terms we call fasting pain and nocturnal pain, is typical of duodenal bulb ulcers. And ulcer disease is an absolute indication for H. pylori screening and treatment. So, I immediately wrote a lab order for a breath test and had my child tested. An hour later, the test results came back and were indeed positive, suggesting the presence of H. pylori infection in the child. At this point the father said, “Doctor, do you remember me? You are my life saver.” I said, “Yes, I remember, can you give me your name?” As soon as he said his name, I immediately remembered that this father was a patient I had seen 10 years ago. He was in his 40s at the time, and at that time he was also seen for intermittent epigastric pain, typical of a duodenal ulcer combined with H. pylori infection. Considering that he was already in his 40s at that time, although the symptoms of duodenal ulcer were typical, according to the treatment principle, patients of this age should pay attention to the possibility of exclusion of cancer, and patients with gastric sinus cancer may also show symptoms similar to duodenal ulcer because the lesion is close to the duodenal bulb, I suggested him to have a gastroscopy first to exclude the possibility of gastric cancer. He said at that time, “I have had ulcer disease for many years and had gastroscopy more than 10 years ago, so I will not get stomach cancer, you can just prescribe me medicine. Since H. pylori is an important causative factor of gastric cancer and the patient was in his 40s and had not undergone gastroscopy for more than 10 years, although the incidence of gastric cancer was not that high, I suggested him to rule out the possibility of gastric cancer first, and with my insistence, the patient underwent gastroscopy. During the gastroscopy, a duodenal ulcer was indeed found, but at the same time, there was a patchy erosion near the patient’s pylorus (the place where the stomach exits) and the color of the mucosa was different from the surrounding area. After biopsy pathological examination, it suggested gastric cancer, which was relatively early because the lesion was superficial. I gave the patient eradication treatment for H. pylori infection, and the patient also underwent surgery without any problem. Since the gastric cancer was relatively early, no chemotherapy was needed after surgery. The discovery of this patient’s gastric cancer was accidental. Early gastric cancer is usually asymptomatic, and the patient’s symptoms at that time were caused by duodenal ulcer rather than gastric cancer, and if he had not undergone gastroscopy at that time, but treated duodenal ulcer and H. pylori infection directly, his symptoms would certainly have been relieved, but he would have missed the opportunity of early detection of gastric cancer. Due to my adherence to my principles and the patient’s active cooperation, his early gastric cancer was detected, thus preventing him from having the risk of death caused by the late detection of gastric cancer. Because of this, the patient said I was his life-saver. During this father’s post-operative review, I had repeatedly instructed him to make sure that his children (first-degree relatives) were screened for H. pylori between the ages of 16 and 18, and that if H. pylori infection was present, they should receive early eradication treatment. (Note: Most people acquire H. pylori infection in childhood, and children are susceptible to H. pylori. If eradication treatment is performed too early, on the one hand, many drugs are prohibited in childhood, and on the other hand, excessive use of antibiotics in childhood is prone to adverse reactions. (If treatment is not indicated, we usually recommend screening and treatment in adulthood.) Now that the child is 17 years old and showing typical symptoms of ulcer disease, the father, always remembering my words back then, immediately brings the child to the hospital. I prescribed medication for H. pylori and ulcers. (Note: The medication for H. pylori includes an acid suppressant, which is the main medication for ulcer disease, so while treating H. pylori, you are also treating the ulcer.) Here, I wish I could tell the following points: 1. For patients aged 40 to 45 years or older who are found to have H. pylori, care should be taken to rule out the possibility of gastric cancer before proceeding with H. pylori eradication treatment. Since China is a country with a high incidence of gastric cancer worldwide, nearly half of the new and dead cases of gastric cancer worldwide occur in China every year, and H. pylori is a class I carcinogenic factor of gastric cancer, and early gastric cancer has no specific clinical manifestations and usually no obvious symptoms, so gastroscopy screening is crucial. 2. First-degree relatives of gastric cancer patients should be screened and treated for H. pylori infection. The occurrence of gastric cancer is multifactorial, including genetic, environmental and infection factors. For patients with family history of gastric cancer, their risk of gastric cancer is significantly higher, and a lot of clinical studies have shown that eradication of H. pylori can significantly reduce the risk of gastric cancer in infected patients, especially for those with family history of gastric cancer. 3. Peptic ulcer disease is an absolute indication for the detection and eradication treatment of H. pylori infection. The symptoms of peptic ulcer can seriously affect the life of patients, and its possible complications (gastrointestinal bleeding and perforation) can lead to the risk of death. H. pylori infection is an important causative factor in the occurrence and recurrence of peptic ulcer, therefore, patients with active peptic ulcer and those with a history of ulcer should be screened and treated for H. pylori infection. 4, H. pylori infection has family aggregation characteristics, children are susceptible population. H. pylori is mainly transmitted between family members, most infected people get infected in childhood, couples may also be infected with each other. Advocating meal sharing can reduce the risk of mutual transmission among family members.