TSUNG-HSIEN CHIANGChang W.-J.Chen S.L.-S.Yen A.M.-F.Fann J.C.-Y.Chiu S.Y.-H.Chen Y.-R.Chuang S.-L.Shieh C.-F.Liu C.-Y.HAN-MO CHIUChiang H.CHIA-TUNG SHUNLin M.-W.MING-SHIANG WULin J.-T.CHANG-CHUAN CHANGraham D.Y.Chen, Tony Hsiu HsiTony Hsiu HsiChenYI-CHIA LEE2021-02-022021-02-0220210017-5749https://www.scopus.com/inward/record.uri?eid=2-s2.0-85088369325&doi=10.1136%2fgutjnl-2020-322200&partnerID=40&md5=8217e09d16660a4ede02a33217e0e458https://scholars.lib.ntu.edu.tw/handle/123456789/545371Objective 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 ?[SDGs]SDG3amoxicillin; clarithromycin; esomeprazole; lansoprazole; levofloxacin; metronidazole; tetracycline; urea c 13; antiinfective agent; adult; antibiotic resistance; Article; atrophic gastritis; Barrett esophagus; cancer incidence; cancer mortality; chemoprophylaxis; clinical effectiveness; cohort analysis; controlled study; digestive system cancer; disease severity; eradication therapy; esophagus cancer; female; gastroscopy; Helicobacter infection; high risk population; human; human tissue; intestine metaplasia; major clinical study; male; mass screening; middle aged; outcome assessment; patient referral; peptic ulcer; precancer; prevalence; priority journal; reflux esophagitis; reinfection; stomach biopsy; stomach cancer; Taiwan; Taiwanese; urea breath test; disease eradication; Helicobacter infection; Helicobacter pylori; incidence; mortality; procedures; stomach tumor; Anti-Bacterial Agents; Disease Eradication; Female; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Incidence; Male; Mass Screening; Middle Aged; Stomach Neoplasms; Taiwanjournal article10.1136/gutjnl-2020-322200327923352-s2.0-85088369325