Helicobacter pylori infection is the major cause of gastric cancer, and removal of H. pylori infection from a population could theoretically decrease the number of non-cardiac gastric cancer by about 89%. However, in the real-life settings, implementation of this strategy on the population level is rarely seen.
Helicobacter pylori infection is the major cause of gastric cancer, and removal of H. pylori infection from a population could theoretically decrease the number of non-cardiac gastric cancer by about 89%. However, in the real-life settings, implementation of this strategy on the population level is rarely seen. This is mainly because of a poor understanding of the magnitude of benefit from H pylori eradication among diverse populations, who have different interaction between host genetic and bacterial virulent factors and thus harbor different levels of gastric cancer risk1, the lack of an adequate infrastructure for delivery of systematic screening services to asymptomatic individuals2, and the lack of standardized treatment regimens based on the antibiotic resistance pattern, clinical efficacy, side effects, simplicity, duration, and cost.3-5 Furthermore, the program must also be integrated into national healthcare priorities to allow the limited resources to be most effectively allocated.
In Taiwan, programmatic gastric cancer prevention was started in 2004 for a high-risk population on an offshore island utilizing the strategy of mass eradication of H. pylori.6 Based on the favorable results of that program over more than one decade of follow-up, the staged implementation of this policy has been expanded gradually to other counties and cities. This presentation will introduce the rationale and workflow of the screen-and-treat strategy for H. pylori infection with special emphasis on how to design and implement such a strategy on the population level.
References:
1.Lee YC, Chiang TH, Chou CK, et al. Association between Helicobacter pylori eradication and gastric cancer incidence: A systematic review and meta-analysis. Gastroenterology. 2016;150:1113-24.e5.
2.Lee YC, Lin JT. Screening and treating Helicobacter pylori infection for gastric cancer prevention on the population level. J Gastroenterol Hepatol. 2017 Jan 14. doi: 10.1111/jgh.13726.
3.Liou JM, Chen CC, Chen MJ, et al; Taiwan Helicobacter Consortium. Sequential versus triple therapy for the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial. Lancet. 2013;381(9862):205-13.
4.Graham DY, Lee YC, Wu MS. Rational Helicobacter pylori therapy: evidence-based medicine rather than medicine-based evidence. Clin Gastroenterol Hepatol. 2014;12(2):177-86.e3; Discussion e12-3.
5.Liou JM, Fang YJ, Chen CC, et al; Taiwan Gastrointestinal Disease and Helicobacter Consortium. Concomitant, bismuth quadruple, and 14-day triple therapy in the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial. Lancet. 2016;388(10058):2355-5.
6.Lee YC, Chen TH, Chiu HM, et al. The benefit of mass eradication of Helicobacter pylori infection: a community-based study of gastric cancer prevention. Gut. 2013;62:676-82.