The benefit of mass eradication of Helicobacter pylori infection: a community-based study of gastric cancer prevention.
OBJECTIVE
To evaluate the benefit of mass eradication of Helicobacter pylori infection in reducing premalignant gastric lesions.


METHODS
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.
Division of Biostatistics, Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Yi-Chia
YC
Lee
Tony Hsiu-Hsi
TH
Chen
Han-Mo
HM
Chiu
Chia-Tung
CT
Shun
Hung
H
Chiang
Tzeng-Ying
TY
Liu
Ming-Shiang
MS
Wu
Jaw-Town
JT
Lin
D000328:Adult; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001944:Breath Tests; D017291:Clarithromycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D016480:Helicobacter pylori / Q000187:drug effects; D006801:Humans; D015994:Incidence; D008297:Male; D008679:Metaplasia / Q000382:microbiology / Q000517:prevention & control; D008875:Middle Aged; D009098:Multiphasic Screening; D016017:Odds Ratio; D010437:Peptic Ulcer / Q000382:microbiology / Q000517:prevention & control; D011230:Precancerous Conditions / Q000382:microbiology / Q000517:prevention & control; D015995:Prevalence; D012008:Recurrence; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000382:microbiology* / Q000517:prevention & control*; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D017291:Clarithromycin