The benefit of mass eradication of Helicobacter pylori infection: a community-based study of gastric cancer prevention.
The benefit of mass eradication of Helicobacter pylori infection: a community-based study of gastric cancer prevention.
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DOI：
10.1136/gutjnl-2012-302240
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发表时间：
2013-05
期刊：
影响因子：
24.5
通讯作者：
Lin JT
中科院分区：
文献类型：
--
作者：
Lee YC;Chen TH;Chiu HM;Shun CT;Chiang H;Liu TY;Wu MS;Lin JT
评价大规模根除幽门螺杆菌感染对减少胃癌前病变的益处。从2004年开始，对台湾30岁以上的幽门螺杆菌感染人群进行大规模根除。 13 C-尿素呼气试验阳性的参与者接受内镜筛查和1周克拉霉素三联治疗。对于初始治疗失败的受试者，给予10天基于左氧氟沙星的三联治疗。主要结果指标是幽门螺杆菌感染和癌前病变患病率的变化，以及使用各种对照品进行化学预防之前（1995-2003年）和之后（2004-2008年）癌前病变和胃癌发病率的变化。幽门螺杆菌感染减少78.7%（95% CI 76.8%至80.7%），估计的再感染/复发发生率为1%（95% CI 0.6%至1.4%）/人-年。减少化学预防引起的胃萎缩发生率的有效性为77.2%（95%CI 72.3%至81.2%），而肠上皮化生的减少不显著。与化学预防前5年相比，在没有内镜筛查的情况下，化学预防期间降低胃癌发病率的有效性为25%（率比0.753，95%CI 0.372至1.524）。治疗后，消化性溃疡的发病率降低了67.4%（95% CI 52.2%至77.8%），而食管炎的发病率为6%（95% CI 5.1%至6.9%）。以人群为基础根除幽门螺杆菌感染导致胃萎缩显著减少，但食管炎增加。降低胃癌发病率和死亡率的最终益处应通过进一步的长期随访来验证。NCT00155389。
To evaluate the benefit of mass eradication of Helicobacter pylori infection in reducing premalignant gastric lesions. 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 13C-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. 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. 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. NCT00155389.
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DOI：
10.1086/590158
发表时间：
2008-08-15
期刊：
The Journal of infectious diseases
影响因子：
--
作者：
Chen Y;Blaser MJ
通讯作者：
Blaser MJ
影响因子：
168.9
作者：
Parsonnet, J;Harris, RA;Owens, DK
通讯作者：
Owens, DK
影响因子：
24.5
作者：
Leung, WK;Lin, SR;Sung, JJY
通讯作者：
Sung, JJY
影响因子：
158.5
作者：
Uemura, N;Okamoto, S;Schlemper, RJ
通讯作者：
Schlemper, RJ
影响因子：
4.4
作者：
Lee, Yi-Chia;Wu, Hui-Min;Lin, Jaw-Town
通讯作者：
Lin, Jaw-Town