The benefit of mass eradication of Helicobacter pylori infection: a community-based study of gastric cancer prevention.

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 (13)C-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.

• Authors: Yi-Chia Lee, Tony Hsiu-Hsi Chen, Han-Mo Chiu, Chia-Tung Shun, Hung Chiang, Tzeng-Ying Liu, Ming-Shiang Wu, Jaw-Town Lin
• Journal: Gut (Gut) Vol. 62 Issue 5 Pg. 676-82 (May 2013) ISSN: 1468-3288 [Electronic] England
• PMID: 22698649 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Anti-Ulcer Agents
• Clarithromycin

Topics

• Adult
• Algorithms
• Anti-Bacterial Agents (therapeutic use)
• Anti-Ulcer Agents (therapeutic use)
• Breath Tests
• Clarithromycin (therapeutic use)
• Drug Therapy, Combination
• Female
• Follow-Up Studies
• Helicobacter Infections (diagnosis, drug therapy, epidemiology)
• Helicobacter pylori (drug effects)
• Humans
• Incidence
• Male
• Metaplasia (microbiology, prevention & control)
• Middle Aged
• Multiphasic Screening
• Odds Ratio
• Peptic Ulcer (microbiology, prevention & control)
• Precancerous Conditions (microbiology, prevention & control)
• Prevalence
• Recurrence
• Risk Factors
• Stomach Neoplasms (microbiology, prevention & control)
• Taiwan (epidemiology)
• Treatment Outcome