School-Based Helicobacter pylori Screening for Adolescents in Japan: Current Status, Challenges, and Implications: A Narrative Review.

BACKGROUND: Japan has a high incidence of gastric cancer and is currently the only nation in which guidelines recommend Helicobacter pylori screening for adolescents. However, the implementation and implications of these initiatives have not been comprehensively characterized. The aim of this study was to provide a comprehensive overview of H. pylori screening programs for adolescents in Japan. MATERIALS AND METHODS: A narrative review was conducted to summarize the studies on H. pylori screening among adolescents in Japan. Literature searches were performed in PubMed, Ichushi-Web, CiNii Research, and J-STAGE for articles published up to February 12, 2026. Studies that described H. pylori screening programs targeting adolescents in Japan were included. Data were extracted on study background and objectives, target age, screening methods, participation rates, infection prevalence, eradication regimens, eradication success rates, and adverse events. RESULTS: Seventeen studies met the inclusion criteria. Screening programs were typically local-government-led and school-based and primarily targeted junior high school students. A two-step diagnostic strategy employing noninvasive tests was commonly used. The median prevalence of H. pylori infection was 3.1%. Eradication regimens varied across programs; metronidazole- or vonoprazan-containing regimens generally showed higher eradication success rates than proton pump inhibitor-based clarithromycin-containing regimens, although cross-study comparisons should be interpreted cautiously because of heterogeneity. Adverse events were generally mild and predominantly gastrointestinal, and no serious complications were reported. CONCLUSIONS: Local-government-led and school-based H. pylori screening among adolescents in Japan represents a feasible approach to the prevention of gastric cancer within a well-established school health system. The applicability of this strategy to other countries depends on several contextual factors, including the incidence of gastric cancer, health care infrastructure, and the presence of organized school health systems. In settings that lack these conditions, alternative community-based strategies may be required.