Screening and eradication of Helicobacter pylori for gastric cancer prevention: the Taipei global consensus

Liou JM 1 , Malfertheiner P 2 , Lee YC 1 , Sheu BS 3 , Sugano K 4 , Cheng HC 3 Show all authors , Yeoh KG 5 , Hsu PI 6 , Goh KL 7 , Mahachai V 8 , Gotoda T 9 , Chang WL 3 , Chen MJ 1 , Chiang TH 1 , Chen CC 1 , Wu CY 10 , Leow AH 7 , Wu JY 11 , Wu DC 11 , Hong TC 1 , Lu H 12 , Yamaoka Y 13 , Megraud F 14 , Chan FKL 15 , Sung JJ 15 , Lin JT 1 , Graham DY 16 , Wu MS 17 , El-Omar EM 18 , Asian Pacific Alliance on Helicobacter and Microbiota (APAHAM)

Affiliations 

  • 1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  • 2 Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
  • 3 Department of Internal Medicine and Institute of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  • 4 Department of Medicine, Jichi Medical School, Tochigi, Japan
  • 5 Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  • 6 Division of Gastroenterology and Hepatology, Department of Internal Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan
  • 7 Department of Gastroenterology and Hepatology, University of Malaya, Kuala Lumpur, Malaysia
  • 8 Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • 9 Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
  • 10 Institute of Biomedical Informatics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
  • 11 Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
  • 12 Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
  • 13 Oita University Faculty of Medicine, Yufu, Oita, Japan
  • 14 French National Reference Centre for Helicobacters, Bacteriology laboratory, Pellegrin Hospital, Bordeaux, & INSERM U1053, University of Bordeaux, Bordeaux, France
  • 15 Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, China
  • 16 Department of Medicine, Michael E DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
  • 17 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan mingshiang@ntu.edu.tw
  • 18 Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia
Gut, 2020 12;69(12):2093-2112.
PMID: 33004546 DOI: 10.1136/gutjnl-2020-322368

Abstract

OBJECTIVE: A global consensus meeting was held to review current evidence and knowledge gaps and propose collaborative studies on population-wide screening and eradication of Helicobacter pylori for prevention of gastric cancer (GC).

METHODS: 28 experts from 11 countries reviewed the evidence and modified the statements using the Delphi method, with consensus level predefined as ≥80% of agreement on each statement. The Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach was followed.

RESULTS: Consensus was reached in 26 statements. At an individual level, eradication of H. pylori reduces the risk of GC in asymptomatic subjects and is recommended unless there are competing considerations. In cohorts of vulnerable subjects (eg, first-degree relatives of patients with GC), a screen-and-treat strategy is also beneficial. H. pylori eradication in patients with early GC after curative endoscopic resection reduces the risk of metachronous cancer and calls for a re-examination on the hypothesis of 'the point of no return'. At the general population level, the strategy of screen-and-treat for H. pylori infection is most cost-effective in young adults in regions with a high incidence of GC and is recommended preferably before the development of atrophic gastritis and intestinal metaplasia. However, such a strategy may still be effective in people aged over 50, and may be integrated or included into national healthcare priorities, such as colorectal cancer screening programmes, to optimise the resources. Reliable locally effective regimens based on the principles of antibiotic stewardship are recommended. Subjects at higher risk of GC, such as those with advanced gastric atrophy or intestinal metaplasia, should receive surveillance endoscopy after eradication of H. pylori.

CONCLUSION: Evidence supports the proposal that eradication therapy should be offered to all individuals infected with H. pylori. Vulnerable subjects should be tested, and treated if the test is positive. Mass screening and eradication of H. pylori should be considered in populations at higher risk of GC.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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