YI-CHIA LEEChen, Tony Hsiu HsiTony Hsiu HsiChenHAN-MO CHIUCHIA-TUNG SHUNChiang H.Liu T.-Y.MING-SHIANG WULin J.-T.2021-03-182021-03-1820130017-5749https://scholars.lib.ntu.edu.tw/handle/123456789/553170Objective 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 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. 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.[SDGs]SDG3amoxicillin; clarithromycin; esomeprazole; levofloxacin; adult; article; cancer diagnosis; cancer incidence; cancer mortality; cancer prevention; cohort analysis; community care; drug safety; drug treatment failure; eradication therapy; esophagitis; esophagogastroduodenoscopy; female; Helicobacter infection; human; infection control; intestine metaplasia; longitudinal study; major clinical study; male; mass screening; nonhuman; outcome assessment; peptic ulcer; precancer; prevalence; priority journal; stomach cancer; Taiwan; unspecified side effect; urea breath test; Adult; Algorithms; Anti-Bacterial Agents; Anti-Ulcer Agents; Breath Tests; Clarithromycin; Drug Therapy, Combination; Female; Follow-Up Studies; Helicobacter Infections; Helicobacter pylori; Humans; Incidence; Male; Metaplasia; Middle Aged; Multiphasic Screening; Odds Ratio; Peptic Ulcer; Precancerous Conditions; Prevalence; Recurrence; Risk Factors; Stomach Neoplasms; Taiwan; Treatment Outcomejournal article10.1136/gutjnl-2012-302240226986492-s2.0-84875826886