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Original article
The benefit of mass eradication of Helicobacter pylori infection: a community-based study of gastric cancer prevention
  1. Yi-Chia Lee1,2,
  2. Tony Hsiu-Hsi Chen1,
  3. Han-Mo Chiu2,
  4. Chia-Tung Shun3,
  5. Hung Chiang4,
  6. Tzeng-Ying Liu5,
  7. Ming-Shiang Wu2,6,
  8. Jaw-Town Lin2
  1. 1Division of Biostatistics, Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
  2. 2Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
  3. 3Department of Pathology, College of Medicine, National Taiwan University, Taipei, Taiwan
  4. 4Institute of Pathology, Taipei, Taiwan
  5. 5Health Bureau of Lienchiang County, Nangan Hsiang, Lienchiang County, Matsu, Taiwan
  6. 6Department of Primary Care Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
  1. Correspondence to Dr Tony Hsiu-Hsi Chen, Division of Biostatistics, Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, Room 533, No 17, Hsuchow Road, Taipei 100, Taiwan; chenlin{at}ntu.edu.twDr Jaw-Town Lin, Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; jawtown{at}ntu.edu.tw

Abstract

Objective To evaluate the benefit of mass eradication of Helicobacter pylori infection in reducing premalignant gastric lesions.

Design Mass eradication of H pylori infection was started from 2004 for a Taiwanese population with prevalent H pylori infection, who were >30 years of age. Participants positive for the 13C-urea breath test underwent endoscopic screening and 1-week clarithromycin-based triple therapy. For subjects whose initial treatment failed, 10-day levofloxacin-based triple therapy was administered. The main outcome measures were changes in the prevalence of H pylori infection and premalignant gastric lesions, and changes in the incidence of premalignant gastric lesions and gastric cancer before (1995–2003) and after (2004–2008) chemoprevention using various comparators.

Results The reduction in H pylori infection was 78.7% (95% CI 76.8% to 80.7%), and the estimated incidence of re-infection/recrudescence was 1% (95% CI 0.6% to 1.4%) per person-year. The effectiveness of reducing the incidence of gastric atrophy resulting from chemoprevention was significant at 77.2% (95% CI 72.3% to 81.2%), while the reduction in intestinal metaplasia was not significant. Compared with the 5-year period before chemoprevention and in the absence of endoscopic screening, the effectiveness in reducing gastric cancer incidence during the chemoprevention period was 25% (rate ratio 0.753, 95% CI 0.372 to 1.524). The reduction in peptic ulcer disease was 67.4% (95% CI 52.2% to 77.8%), while the incidence of oesophagitis was 6% (95% CI 5.1% to 6.9%) after treatment.

Conclusions Population-based eradication of H pylori infection has led to a significant reduction in gastric atrophy at the expense of increased oesophagitis. The ultimate benefit in reducing gastric cancer incidence and its mortality should be validated by a further long-term follow-up.

Trial registration number NCT00155389.

  • Helicobacter pylori
  • gastric cancer
  • chemoprevention
  • cancer prevention
  • endoscopic procedures
  • gastro-oesophageal reflux disease
  • colorectal cancer screening
  • oesophageal cancer
  • cancer epidemiology
  • statistics
  • meta-analysis
  • cancer registries
  • colonoscopy
  • colonic polyps
  • colorectal neoplasia
  • colonic neoplasms
  • colorectal adenomas
  • endoscopic polypectomy
  • colorectal neoplasm
  • endoscopy
  • gastric lymphoma
  • helicobacter pylori - pathogenesis
  • molecular oncology
  • gastrointestinal neoplasia

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Footnotes

  • Funding This study was supported by research grants from the Bureau of Health Promotion, Department of Health, Taiwan (DOH97-TD-M-113-95002), the National Science Council (NSC96-2314-B-002-092-MY3 and 99-2314-B-002-132-MY3), and the National Taiwan University Hospital (98-P21 and 99-P06). The funding source had no role in study design, data collection, analysis or interpretation, report writing or the decision to submit this paper for publication.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The study protocol was approved by the institutional review board of National Taiwan University Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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