Current clinical trend and future of GI disorders in Taiwan

Helicobacter pylori (H. pylori) -related peptic ulcer diseases and gastric cancer were prevalent in Taiwan in the past. A population-based H. pylori eradication program was launched in the Matsu Island with a high a high incidence rate of gastric cancer in 2004. This program provided the evidence that mass eradication of H. pylori infection was associated with a significant reduction in gastric atrophy. However, the eradication rate of standard triple therapy was only around 85% in Taiwan. In a current randomized trial, we found that the eradication rates for sequential therapy for 14 days and sequential therapy for 10 days were more efficacious than triple therapy for 14 days. Taiwan has experienced a remarkable increase of both incidence and mortality from colorectal cancer (CRC) in the past two decades. Taiwan government has launched nation-wide CRC screening service program since 2004. Until now, more than 1 million Taiwanese peoples have ever received this CRC screening with a positive rate of 4% and confirmatory exam rate of 80%. Among the screening detected CRCs, 70% were stage II or earlier cancers and significant down staging was observed. Our society is now making effort on evaluating and promulgating several quality indicators of colonoscopy. Although IBD is increasing, prospective, population-based epidemiologic study remains lacking in Taiwan. Compared to the US, choice of medications is limited. HBV/TB are always considered when treating IBD, particularly with steroid, immunomodulators, and anti-TNF. There is currently trend of increasing prevalence of GERD/NERD in Taiwan due to westernization of lifestyle and increasing obesity and metabolic syndrome. Endoscopy remains as the mainstay for diagnosis of GERD/NERD and exclusion other upper GI pathology. PPI is under strict regulation for the GERD prescription only after diagnosis of erosive esophagitis (EE) by endoscopy. The prevalence of Barrett's esophagus remains low. The disease burden of esophageal cancer is still increasing in Taiwan. Primary prevention is a difficult mission. Because of lacking an appropriate nationwide screening program. Application of image-enhanced endoscopy , such as narrow band imaging, can help us to diagnose early esophageal cancer.which could be resected by endoscopic submucosal dissection to improve the outcome. However, high recurrence rate and lack an effective chemoprevention agent remains problematic.