Lee Yi-Chia, Lin Jaw-Town
Department of Internal Medicine, National Taiwan University, Taipei, Taiwan.
School of Medicine and Big Data Research Centre, Fu Jen Catholic University, New Taipei City, Taiwan.
J Gastroenterol Hepatol. 2017 Jun;32(6):1160-1169. doi: 10.1111/jgh.13726.
Helicobacter pylori infection is the major cause of gastric cancer, and removal of H. pylori infection from a population could theoretically decrease the number of cases by about 89%. However, in real-life settings, few studies have reported the effect of screening and treating this pathogen in population-based programs. This is mainly because of the lack of an adequate infrastructure for delivery of systematic screening services to asymptomatic individuals, the lack of standardization to ensure that each subject receives the correct diagnostic testing and antibiotic treatment, and limited resources. We illustrate our method of implementing two population-based screen-and-treat programs in Taiwan, where the epidemiological characteristics of disease burden have changed from the traditionally Eastern pattern towards that of the Western countries. Our first example is a high-risk population that resides on an offshore island, in which a strategy of mass eradication of H. pylori was applied. The other example is an intermediate-risk population, which is representative of the general average-risk population, in which there is integration of the screen-and-treat method with the established framework of colorectal cancer screening using the fecal-occult blood test. The information provided here may be useful for integration of gastric cancer prevention measures into the healthcare priorities of populations with different gastric cancer risks, such as those with limited resources.
幽门螺杆菌感染是胃癌的主要病因，理论上从人群中清除幽门螺杆菌感染可使病例数减少约89%。然而，在现实生活中，很少有研究报告在基于人群的项目中筛查和治疗这种病原体的效果。这主要是因为缺乏为无症状个体提供系统筛查服务的适当基础设施，缺乏确保每个受试者接受正确诊断测试和抗生素治疗的标准化，以及资源有限。我们阐述了在台湾实施两项基于人群的筛查和治疗项目的方法，在台湾，疾病负担的流行病学特征已从传统的东方模式转变为西方国家的模式。我们的第一个例子是居住在离岛上的高危人群，在该人群中应用了大规模根除幽门螺杆菌的策略。另一个例子是中度风险人群，该人群代表一般平均风险人群，在该人群中，筛查和治疗方法与使用粪便潜血试验的既定结直肠癌筛查框架相结合。此处提供的信息可能有助于将胃癌预防措施纳入具有不同胃癌风险人群（如资源有限人群）的医疗保健优先事项中。
