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Original research
Mass eradication of Helicobacter pylori to reduce gastric cancer incidence and mortality: a long-term cohort study on Matsu Islands
  1. Tsung-Hsien Chiang1,2,3,
  2. Wei-Jung Chang4,
  3. Sam Li-Sheng Chen5,
  4. Amy Ming-Fang Yen5,
  5. Jean Ching-Yuan Fann6,
  6. Sherry Yueh-Hsia Chiu7,8,
  7. Yi-Ru Chen9,
  8. Shu-Ling Chuang4,10,
  9. Chun-Fu Shieh11,
  10. Cheng-Ying Liu12,
  11. Han-Mo Chiu1,4,
  12. Hung Chiang13,
  13. Chia-Tung Shun14,15,
  14. Ming-Wei Lin16,
  15. Ming-Shiang Wu1,
  16. Jaw-Town Lin1,17,
  17. Chang-Chuan Chan18,19,
  18. David Y Graham20,
  19. Hsiu-Hsi Chen4,19,
  20. Yi-Chia Lee1,4,10,19
  1. 1 Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
  2. 2 Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
  3. 3 Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
  4. 4 Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
  5. 5 School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
  6. 6 Department of Health Industry Management, Kainan University, Taoyuan, Taiwan
  7. 7 Department of Health Care Management and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
  8. 8 Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
  9. 9 Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
  10. 10 Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
  11. 11 Health Bureau of Lienchiang County, Nangan Township, Lienchiang County, Matsu, Taiwan
  12. 12 Lienchiang County Government, Nangan Township, Lienchiang County, Matsu, Taiwan
  13. 13 Taipei Institute of Pathology, Taipei, Taiwan
  14. 14 Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
  15. 15 Department and Graduate Institute of Forensic Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
  16. 16 Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
  17. 17 Center for Digestive Medicine, China Medical University Hospital, Taichung, Taiwan
  18. 18 Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
  19. 19 Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
  20. 20 Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
  1. Correspondence to Dr Yi-Chia Lee, Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; yichialee{at}ntu.edu.tw

Abstract

Objective Although mass eradication of Helicobacter pylori has been proposed as a means to eliminate gastric cancer, its long-term effects remain unclear.

Design Mass eradication of H. pylori infection was launched in 2004 and continued until 2018 for a high-risk Taiwanese population aged 30 years or older dwelling on Matsu Islands with prevalent H. pylori infection. Test positives for the 13C-urea breath test underwent eradication therapy. We evaluated the effectiveness of the mass eradication in reducing two main outcomes, incidence and mortality rates of gastric cancer, until the end of 2016 and 2018, respectively.

Results After six rounds of mass screening and eradication, the coverage rate reached 85.5% (6512/7616). The referral rate for treatment was 93.5% (4286/4584). The prevalence rates of H. pylori fell from 64.2% to 15.0% with reinfection rates of less than 1% per person-year. The presence and severity of atrophic gastritis and intestinal metaplasia also decreased with time. Compared with the historical control period from 1995 to 2003, the effectiveness in reducing gastric cancer incidence and mortality during the chemoprevention period was 53% (95% CI 30% to 69%, p<0.001) and 25% (95% CI −14% to 51%, p=0.18), respectively. No significant changes were noted in the incidence rates of other digestive tract cancers or the antibiotic resistance rate of H. pylori.

Conclusion Population-based eradication of H. pylori has significantly reduced gastric cancer incidence with no increase in the likelihood of adverse consequences. A significant reduction in mortality is likely to be achieved with a longer follow-up period.

Trial registration number NCT00155389

  • cancer prevention
  • gastric cancer
  • helicobacter pylori
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Footnotes

  • H-HC and Y-CL contributed equally.

  • Contributors Y-CL and H-HC had full access to the data and took responsibility for the integrity of the data, and the accuracy of the data analysis. Conception and design of the study: Y-CL and H-HC. Generation, collection, assembly, analysis and/or interpretation of data: All authors. Pathological analysis: HC and C-TS. Statistical analysis: T-HC, W-JC, Y-CL and H-HC. Drafting or revision of the manuscript: T-HC, DYG, Y-CL and H-HC. Clinical reasoning and critical revision of the manuscript for important intellectual content: T-HC, DYG, Y-CL and H-HC. Administrative, technical or material support: All authors. Approval of the final version of the manuscript: All authors. Study supervision: C-YL (policy development and administrative support), Y-CL (programme execution and evaluation), and H-HC (program execution and evaluation). Y-CL had the final responsibility for the decision to submit for publication.

  • Funding This study was supported by the Minister of Science and Technology, R.O.C. (105-2314-B-002-069-MY3 and 108-2314-B-002-140-MY3) and Taipei Institute of Pathology (TIP-106-005). The programme was also supported by grants from the Innovation and Policy Center for Population Health and Sustainable Environment (Population Health Research Center, PHRC), College of Public Health, National Taiwan University from the Ministry of Science and Technology (107-3017-F-002-003), the Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan (NTU-107L9003), and the National Taiwan University Hospital (107-T11).

  • Disclaimer The funding sources had no role in study design, data collection, analysis or interpretation, report writing or the decision to submit this paper for publication.

  • Competing interests DYG is a consultant for RedHill Biopharma and Phathom Pharmaceuticals regarding novel H. pylori therapies and has received research support for culture of Helicobacter pylori. The rest authors have no conflicts of interest.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Ethics approval All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1964 and later versions. The Research Ethics Committee of National Taiwan University Hospital (IRB No: 940110) approved the protocol for this programme. Informed consent was obtained from all patients in the study.

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

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as online supplementary information.

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