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Screening and eradication of Helicobacter pylori for gastric cancer prevention: the Taipei global consensus
  1. Jyh-Ming Liou1,2,3,
  2. Peter Malfertheiner4,5,
  3. Yi-Chia Lee1,2,6,
  4. Bor-Shyang Sheu7,8,
  5. Kentaro Sugano9,
  6. Hsiu-Chi Cheng7,10,
  7. Khay-Guan Yeoh11,
  8. Ping-I Hsu12,
  9. Khean-Lee Goh13,
  10. Varocha Mahachai14,
  11. Takuji Gotoda15,
  12. Wei-Lun Chang7,
  13. Mei-Jyh Chen1,2,16,
  14. Tsung-Hsien Chiang1,2,16,
  15. Chieh-Chang Chen1,2,
  16. Chun-Ying Wu17,18,
  17. Alex Hwong-Ruey Leow13,
  18. Jeng-Yih Wu8,
  19. Deng-Chyang Wu8,
  20. Tzu-Chan Hong1,2,19,
  21. Hong Lu20,
  22. Yoshio Yamaoka21,22,
  23. Francis Megraud23,
  24. Francis K L Chan24,25,
  25. Joseph JY Sung24,25,
  26. Jaw-Town Lin1,26,
  27. David Y Graham22,
  28. Ming-Shiang Wu1,2,
  29. Emad M El-Omar27,28
  30. Asian Pacific Alliance on Helicobacter and Microbiota (APAHAM)
  1. 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  2. 2Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
  3. 3Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
  4. 4Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
  5. 5Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
  6. 6Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
  7. 7Department of Internal Medicine and Institute of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  8. 8Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
  9. 9Department of Medicine, Jichi Medical School, Tochigi, Japan
  10. 10Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
  11. 11Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  12. 12Division of Gastroenterology and Hepatology, Department of Internal Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan
  13. 13Department of Gastroenterology and Hepatology, University of Malaya, Kuala Lumpur, Malaysia
  14. 14Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  15. 15Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
  16. 16Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
  17. 17Institute of Biomedical Informatics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
  18. 18Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
  19. 19Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan
  20. 20Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
  21. 21Oita University Faculty of Medicine, Yufu, Oita, Japan
  22. 22Department of Medicine, Michael E DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
  23. 23French National Reference Centre for Helicobacters, Bacteriology laboratory, Pellegrin Hospital, Bordeaux, & INSERM U1053, University of Bordeaux, Bordeaux, France
  24. 24Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, China
  25. 25Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
  26. 26Digestive Medicine Center, China Medical University Hospital, Taichung, Taiwan
  27. 27Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  28. 28Microbiome Research Centre, St George & Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
  1. Correspondence to Professor Ming-Shiang Wu, Department of Internal Medicine, National Taiwan University Hospital, Taipei 10002, Taiwan; mingshiang{at}ntu.edu.tw

Abstract

Objective A global consensus meeting was held to review current evidence and knowledge gaps and propose collaborative studies on population-wide screening and eradication of Helicobacter pylori for prevention of gastric cancer (GC).

Methods 28 experts from 11 countries reviewed the evidence and modified the statements using the Delphi method, with consensus level predefined as ≥80% of agreement on each statement. The Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach was followed.

Results Consensus was reached in 26 statements. At an individual level, eradication of H. pylori reduces the risk of GC in asymptomatic subjects and is recommended unless there are competing considerations. In cohorts of vulnerable subjects (eg, first-degree relatives of patients with GC), a screen-and-treat strategy is also beneficial. H. pylori eradication in patients with early GC after curative endoscopic resection reduces the risk of metachronous cancer and calls for a re-examination on the hypothesis of ‘the point of no return’. At the general population level, the strategy of screen-and-treat for H. pylori infection is most cost-effective in young adults in regions with a high incidence of GC and is recommended preferably before the development of atrophic gastritis and intestinal metaplasia. However, such a strategy may still be effective in people aged over 50, and may be integrated or included into national healthcare priorities, such as colorectal cancer screening programmes, to optimise the resources. Reliable locally effective regimens based on the principles of antibiotic stewardship are recommended. Subjects at higher risk of GC, such as those with advanced gastric atrophy or intestinal metaplasia, should receive surveillance endoscopy after eradication of H. pylori.

Conclusion Evidence supports the proposal that eradication therapy should be offered to all individuals infected with H. pylori. Vulnerable subjects should be tested, and treated if the test is positive. Mass screening and eradication of H. pylori should be considered in populations at higher risk of GC.

  • helicobacter pylori
  • gastric cancer
  • cancer prevention
  • screening
  • helicobacter pylori - treatment

https://doi.org/10.1136/gutjnl-2020-322368

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    Footnotes

    • DYG, M-SW and EME-O are joint senior authors.

    • Twitter @emadelomar

    • J-ML and PM contributed equally.

    • Contributors Drafts of clinical questions (CQs) about each topic were prepared by J-ML and were further revised by core members (PM, Y-CL, DYG, EME-O and M-SW). Faculty members (J-ML, Y-CL, B-SS, H-CC, KG-Y, W-LC, M-JC, T-HC, C-CC, C-YW, P-IH and M-SW) were assigned to perform systematic review of CQs 1 to 4 and to prepare the statements, which were edited in the first steering committee. The revised draft statements were further edited by moderates and core members (J-ML, PM, Y-CL, B-SS, DYG, EME-O and M-SW). Faculty members (J-ML, Y-CL, B-SS, H-CC, KG-Y, W-LC, M-JC, T-HC, C-CC, C-YW, P-IH and M-SW) drafted the comments after the consensus meeting. J-ML drafted the article, which was critically revised by co-first author PM and three senior authors, DYG, M-SW and EME-O. All authors commented on drafts and approved the final version. All authors had full access to the data and participated in the decision to submit for publication.

    • Funding The study was funded by the National Taiwan University Hospital (grant number: NTUH 107-P05; 109-P03), the Ministry of Science and Technology, Executive Yuan, ROC, Taiwan (grant number: TCTC 108-2321-B-002 -040 - and MOST 108-2314-B-002 -187, 108-2314-B-002 -209 -), the Ministry of Health and Welfare of Taiwan (grant number: MOHW107-TDU-B-211-123002, MOHW108-CDC-C-114-112102), the “Center of Precision Medicine” from The Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan (grant number: NTU-107L9014-1), the Liver Disease Prevention & Treatment Research Foundation, Taiwan, and the Gastroenterological Society of Taiwan (GEST). The GEST received funding from the Takeda Taiwan Co. Ltd (APTC-01), the Eisai Co. Ltd, the Swiss Pharmaceutical Co. (APTC-02), Ltd, the Panion & BF Biotech Inc. (APTC-03), and the Harvester Trading Co. LTD (APTC-04). for the 10th Asian Pacific Topic Conference. DYG is supported in part by the Office of Research and Development Medical Research Service Department of Veterans Affairs, Public Health Service grant DK56338 which funds the Texas Medical Center Digestive Diseases Center. EME-O is funded by grants from the Australian Federal Government to the St George and Sutherland Medical Research Foundation. 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 J-ML reports receiving lecture fees from Takeda Pharmaceuticals (Taiwan) and Abbott Laboratories. PM reports receiving advisory and lecture fees from Bayer, Mayoly Spindler and Nordmark. 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.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

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

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