A Decade of Screening and Treating Helicobacter pylori Infection Among First-Year High School Students in Kyoto, Japan: Annual Trends in Infection, Consultation, and Eradication Success Rates (2015-2023).
This prospective Kyoto school-based program reported declining H. pylori prevalence, higher eradication success after switching from PAC to PAM and later adding CBM588, no reported serious adverse events, and a substantial decline in consultation among screen-positive adolescents.
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This prospective Kyoto school-based program reported declining H. pylori prevalence, higher eradication success after switching from PAC to PAM and later adding CBM588, no reported serious adverse events, and a substantial decline in consultation among screen-positive adolescents.
Research significance
The record supports that adolescent screening linked to PAM-based eradication can achieve high short-term H. pylori clearance in a real-world program; it is an inference, not demonstrated here, that early eradication prevents gastric mucosal atrophy or ultimately reduces gastric cancer incidence.
Source abstract
BACKGROUND: Helicobacter pylori infection is a primary cause of gastric cancer. Although eradication therapy in adulthood suppresses carcinogenesis, its efficacy is limited due to the progression of advanced gastric mucosal atrophy before eradication. Implementing a "screen-and-treat" strategy during adolescence represents a promising approach to prevent advanced atrophy and subsequent gastric cancer. METHODS: This prospective cohort study included first-year high school students in Kyoto Prefecture, Japan, from 2015 to 2023. Screening was performed using a primary urine H. pylori antibody test, followed by a secondary stool antigen test for confirmation. Confirmed positive individuals were referred to designated medical institutions for 7-day eradication therapy. The primary therapeutic regimen was shifted from rabeprazole, amoxicillin, and clarithromycin (PAC) in 2015 to rabeprazole, amoxicillin, and metronidazole (PAM) from 2016 onward. Clostridium butyricum MIYAIRI 588 strain (CBM588) was co-administered starting in 2017. Eradication success was verified via a stool antigen test at least 8 weeks post-treatment. RESULTS: A total of 50,031 students were targeted over the 9-year period, with an overall consent rate ranging from 59.9% to 83.9%. The confirmed H. pylori infection rate declined from 4.7% in 2015 to 1.5% in 2023. The medical consultation rate among positive screenees exhibited a declining trend, peaking at 84.6% (2015) and dropping to 15.8% (2023), despite a temporary increase in 2019 (65.9%). The eradication success rate significantly improved from 76.5% with the PAC regimen (2015) to over 93.8% with the PAM regimen (2016 onward), exceeding 96.0% after the addition of CBM588. No serious adverse events were reported throughout the study period. CONCLUSIONS: The prospective adolescent screen-and-treat program demonstrated a significant decrease in H. pylori infection rates among first-year high school students over the decade. While the safety and efficacy of the PAM-based eradication regimen were verified, declining medical consultation rates present a continuous challenge for public health implementation.