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.

Trial registration: ClinicalTrials.gov NCT00155389.

Figure 1

Gastric cancer prevention programmes implemented on Matsu Island, in chronological order. EGD, oesophagogastroduodenoscopy; UBT, urea breath test.

Figure 2

Individual factors associated with the occurrence of intestinal metaplasia after chemoprevention. The multivariate model adjusted for all variables is shown in the forest plot. HDL-C, high-density lipoprotein cholesterol.

Figure 3

Incidence of gastric cancer between 1995 and 2008, correlated with mass eradication of Helicobacter pylori infection. The trend in gastric cancer incidence over time is represented by the solid line for subjects on Matsu Island and by the dotted line for residents of Taiwan. The closed arrow indicates the start of the chemoprevention programme in 2004, involving endoscopic screening and H pylori treatment.

Figure 4

Individual factors associated with the occurrence of endoscopic oesophagitis after chemoprevention. The multivariate model adjusted for all variables is shown in the forest plot. HDL-C, high-density lipoprotein cholesterol.