| Invited Lecture(JSGE) |
| Sat. November 2nd 14:00 - 14:30 Room 1: Kobe International Exhibition Hall No.2 Building Hall (North) |
| Personalized treatment and long-term safety issues of H. pylori eradication for gastric cancer prevention | |||
| Jyh-Ming Liou | |||
| Department of Internal Medicine, National Taiwan University Hospital | |||
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| Helicobacter pylori (H. pylori) has been shown to be the most important causal factor of gastric cancer. Emerging evidence showed that early eradication of H. pylori before the development of gastric atrophy or intestinal metaplasia may reduce the risk of gastric adenocarcinoma. Our recent systematic review and meta-analysis revealed a decline in the prevalence of H. pylori among adults globally, from 52.6% before 1990 to 43.9% between 2015 and 2022. This decline in global H. pylori prevalence is accompanied by a decrease in the worldwide incidence of gastric cancer. Throughout the period from 1990 to 2022, we observed a gradual increase in antibiotic resistance among H. pylori strains in the Asia-Pacific region. The latest resistance rates have risen to 30% for clarithromycin, 61% for metronidazole, 35% for levofloxacin, 4% for tetracycline, and 6% for amoxicillin. In response, we developed personalized first-line therapies for H. pylori populations in Taiwan. Our large-scale randomized clinical trial demonstrated that 14-day sequential therapy surpasses triple therapy for 14 days. Subsequently, we found that 10-day bismuth quadruple therapy achieves a 90% eradication rate, significantly outperforming the 84% efficacy of traditional 14-day triple therapy. Furthermore, we developed a method for detecting antibiotic resistance genes using gastric biopsy specimens and conducted two clinical trials to demonstrate genotypic resistance guided therapy in first-line and third-line therapy. These trials affirmed that treatment guided by genotypic antibiotic resistance is as effective as traditional methods, thus supporting the application of antibiotic resistance gene testing for personalized H. pylori eradication therapy. In second-line therapy, we showed that sequential quadruple therapy with levofloxacin surpasses triple therapy containing levofloxacin and is comparable to bismuth quadruple therapy. Additionally, we developed personalized treatments for refractory H. pylori infections, and conducted the first randomized trial to confirm that treatment guided by antibiotic resistance gene testing achieves a 78% eradication rate, compared to 72% when treatment is selected based on medication history. We also investigated the long-term safety of eradication therapy on gut microbiota, antibiotic resistance gene profiles, and metabolic indicators. Our findings indicate that asymptomatic adults experience minimal impact on antibiotic resistance and gut microbiota ecology post-eradication, with potential improvements in metabolism. Recently, our shotgun metagenomic analysis further confirmed that gut microbiota antibiotic resistance remains unchanged one year after eradication. These research results provide crucial insights into H. pylori treatment and support the safety of eradication for preventing gastric cancer. |
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