Mass eradication of Helicobacter pylori to reduce gastric cancer incidence and mortality: A long-term cohort study on Matsu Islands

Tsung Hsien Chiang, Wei Jung Chang, Sam Li Sheng Chen, Amy Ming Fang Yen, Jean Ching Yuan Fann, Sherry Yueh Hsia Chiu, Yi Ru Chen, Shu Ling Chuang, Chun Fu Shieh, Cheng Ying Liu, Han Mo Chiu, Hung Chiang, Chia Tung Shun, Ming Wei Lin, Ming Shiang Wu, Jaw Town Lin, Chang Chuan Chan, David Y. Graham, Hsiu Hsi Chen, Yi Chia Lee*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

142 Scopus citations

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 13 C-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

Original languageEnglish
Pages (from-to)243-250
Number of pages8
JournalGut
Volume70
Issue number2
DOIs
StatePublished - 1 Feb 2021

Keywords

  • cancer prevention
  • gastric cancer
  • helicobacter pylori

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