TY - JOUR
T1 - Mass eradication of Helicobacter pylori to reduce gastric cancer incidence and mortality
T2 - a long-term cohort study on Matsu Islands
AU - Chiang, Tsung-Hsien
AU - Chang, Wei-Jung
AU - Chen, Sam Li-Sheng
AU - Yen, Amy Ming-Fang
AU - Fann, Jean Ching-Yuan
AU - Chiu, Sherry Yueh-Hsia
AU - Chen, Yi-Ru
AU - Chuang, Shu-Ling
AU - Shieh, Chun-Fu
AU - Liu, Cheng-Ying
AU - Chiu, Han-Mo
AU - Chiang, Hung
AU - Shun, Chia-Tung
AU - Lin, Ming-Wei
AU - Wu, Ming-Shiang
AU - Lin, Jaw-Town
AU - Chan, Chang-Chuan
AU - Graham, David Y
AU - Chen, Hsiu-Hsi
AU - Lee, Yi-Chia
N1 - Funding Information:
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).
Publisher Copyright:
©
PY - 2021/2
Y1 - 2021/2
N2 - 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.
AB - 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.
KW - cancer prevention
KW - gastric cancer
KW - helicobacter pylori
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U2 - 10.1136/gutjnl-2020-322200
DO - 10.1136/gutjnl-2020-322200
M3 - Article
C2 - 32792335
SN - 0017-5749
VL - 70
SP - 243
EP - 250
JO - Gut
JF - Gut
IS - 2
ER -