Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
Department of Internal Medicine, Institute of Clinical Medicine, Institute of Molecular Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan.
J Formos Med Assoc. 2022 Dec;121(12):2378-2392. doi: 10.1016/j.jfma.2022.08.012. Epub 2022 Sep 7.
Gastric cancer is an inflammation-related cancer triggered by Helicobacter pylori infection. Understanding of the natural disease course has prompted the hypothesis that gastric cancer can be prevented by administering a short-course antibiotic treatment to eradicate the H. pylori infection and interrupt this carcinogenic cascade. Results from randomized controlled trials and cohort studies have repeatedly confirmed this concept, which has moved attention from individual management of H. pylori infection to population-wide implementation of screening programs. Such a paradigm shift follows a three-tier architecture. First, healthcare policy-makers determine the most feasible and applicable eligibility, invitation, testing, referral, treatment, and evaluation methods for an organized screening program to maximize the population benefits and cost-effectiveness. Second, provision of knowledge and effective feedback to frontline general practitioners, including choice of diagnostic tests, selection of eradication regimens, and the indication of endoscopic examination, ensures the quality of care and increases the likelihood of desired treatment responses. Third, initiatives to raise population awareness are designed regarding the impact of H. pylori infection and risky lifestyle habits on the stomach health. These programs, with increased accessibility and geographic coverage in progress, will accelerate the decline in morbidity, mortality, and associated costs of this preventable malignancy.
胃癌是一种与炎症相关的癌症，由幽门螺杆菌感染引发。对其自然病程的理解促使人们提出假设，即通过给予短疗程抗生素治疗根除幽门螺杆菌感染并中断这种致癌级联反应，可以预防胃癌。随机对照试验和队列研究的结果反复证实了这一概念，这使得人们的注意力从个体的幽门螺杆菌感染管理转移到了人群范围的筛查计划实施上。这种范式转变遵循三层架构。首先，医疗保健政策制定者确定最可行和适用的资格、邀请、检测、转介、治疗和评估方法，以实施有组织的筛查计划，使人群获益和成本效益最大化。其次，向一线全科医生提供知识和有效的反馈，包括诊断检测的选择、根除方案的选择以及内镜检查的指征，以确保护理质量并增加期望的治疗反应的可能性。第三，针对幽门螺杆菌感染和危险的生活方式习惯对胃部健康的影响，开展提高人群认识的举措。这些计划正在增加可及性和地理覆盖范围，将加速降低这种可预防恶性肿瘤的发病率、死亡率和相关成本。
