The benefit of mass eradication of Helicobacter pylori infection: a community-based study of gastric cancer prevention
Yi-Chia Lee,Tony Hsiu Hsi Chen,Han-Mo Chiu,Chia-Tung Shun,Hung-Chi Chiang,Tzeng-Ying Liu,Ming-Shiang Wu,Jaw-Town Lin +7 more
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TLDR
Population-based eradication of H pylori infection has led to a significant reduction in gastric atrophy at the expense of increased oesophagitis and the ultimate benefit in reducing gastric cancer incidence and its mortality should be validated by a further long-term follow-up.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 (1995e2003) and after (2004e2008) 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 Hp ylori infectionhasledtoasignificantreductioningastricatrophy at the expense of increased oesophagitis. The ultimate benefitinreducinggastriccancerincidenceanditsmortality should be validated by a further long-term follow-up. Trial registration number NCT00155389.read more
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Management of Helicobacter pylori infection—the Maastricht V/Florence Consensus Report
Peter Malfertheiner,Francis Mégraud,Colm O'Morain,Javier P. Gisbert,Ernst J. Kuipers,A. T. R. Axon,Franco Bazzoli,Antonio Gasbarrini,John Atherton,David Y. Graham,Richard H. Hunt,Paul Moayyedi,Theodore Rokkas,Massimo Rugge,Michael Selgrad,Sebastian Suerbaum,Kentaro Sugano,Emad M. El-Omar +17 more
TL;DR: This fifth edition of the Maastricht Consensus Report describes how experts from 24 countries examined new data related to H. pylori infection in the various clinical scenarios and provided recommendations on the basis of the best available evidence and relevance.
Journal ArticleDOI
Management of Helicobacter pylori infection—the Maastricht IV/ Florence Consensus Report
Peter Malfertheiner,Francis Mégraud,John Atherton,Anthony T. R. Axon,Franco Bazzoli,Gian Franco Gensini,Javier P. Gisbert,David Y. Graham,Ernst J. Kuipers +8 more
TL;DR: In this 4th edition of the Maastricht consensus report aspects related to the clinical role of H pylori were looked at again in 2010, with recommendations to guide doctors involved in the management of this infection associated with various clinical conditions.
Journal ArticleDOI
Kyoto global consensus report on Helicobacter pylori gastritis
Kentaro Sugano,Jan Tack,Ernst J. Kuipers,David Y. Graham,Emad M. El-Omar,Soichiro Miura,Ken Haruma,Masahiro Asaka,Naomi Uemura,Peter Malfertheiner +9 more
TL;DR: A global consensus for gastritis was developed for the first time, which will be the basis for an international classification system and for further research on the subject.
Journal ArticleDOI
Association Between Helicobacter pylori Eradication and Gastric Cancer Incidence: A Systematic Review and Meta-analysis
Yi-Chia Lee,Tsung-Hsien Chiang,Chu-Kuang Chou,Yu-Kang Tu,Wei-Chih Liao,Ming-Shiang Wu,David Y. Graham +6 more
TL;DR: In a systematic review and meta-analysis of randomized controlled trials and observational studies, eradication of H pylori infection is associated with a reduced incidence of gastric cancer.
Journal ArticleDOI
Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomised controlled trials
TL;DR: Limited, moderate quality evidence is provided that searching for and eradicating H pylori reduces the incidence of gastric cancer in healthy asymptomatic infected Asian individuals, but these data cannot necessarily be extrapolated to other populations.
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Classification and grading of gastritis.The updated Sydney system
TL;DR: The Sydney System for the classification of gastritis emphasized the importance of combining topographical, morphological, and etiological information into a schema that would help to generate reproducible and clinically useful diagnoses as discussed by the authors.
Journal ArticleDOI
Helicobacter pylori infection and the development of gastric cancer
Naomi Uemura,Sumika Okamoto,Susumu Yamamoto,Nobuyuki Matsumura,Shigeki Yamaguchi,Michio Yamakido,Kiyomi Taniyama,Noboyuki Sasaki,Ronald J Schlemper +8 more
TL;DR: Gastric cancer develops in persons infected with H. pylori but not in uninfected persons, and those with histologic findings of severe gastric atrophy, corpus-predominant gastritis, or intestinal metaplasia are at increased risk.
Journal Article
Human Gastric Carcinogenesis: A Multistep and Multifactorial Process—First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention
TL;DR: A human model of gastric carcinogenesis with the following sequential stages: chronic gastritis; atrophy; intestinal metaplasia; and dysplasia, which has been linked with the supply of beta-carotene and with excessive salt intake is provided.
Journal ArticleDOI
Current concepts in the management of Helicobacter pylori infection - The Maastricht III Consensus Report
Peter Malfertheiner,Francis Mégraud,Colm O'Morain,Franco Bazzoli,Emad M. El-Omar,David Y. Graham,Richard H. Hunt,Theodore Rokkas,Nimish Vakil,Ernst J. Kuipers +9 more
TL;DR: H pylori eradication is less effective than proton pump inhibitor (PPI) treatment in preventing ulcer recurrence in long term NSAID users and a test and treat strategy using a non-invasive test is recommended in adult patients with persistent dyspepsia under the age of 45.