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Park: Changes in Upper Gastrointestinal Diseases according to Improvement of Helicobacter pylori Prevalence Rate in Korea
Review Article

Korean J Gastroenterol 2015;65(4):199-204.

Published online: 4 October 2015

DOI: https://doi.org/10.4166/kjg.2015.65.4.199

Changes in Upper Gastrointestinal Diseases according to Improvement of Helicobacter pylori Prevalence Rate in Korea

Soo-Heon Park

Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to: Soo-Heon Park, Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, 10 63-ro, Yeongdeungpo-gu, Seoul 150-713, Korea. Tel: +82-2-3779-2093, Fax: +82-2-786-0803, E-mail: psheon5132@naver.com

Copyright © 2015 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Helicobacter pylori can cause variety of upper gastrointestinal disorders such as peptic ulcer, mucosa associated lymphoid tissue (MALT)-lymphoma, and gastric cancer. The prevalence of H. pylori infection has significantly decreased in Korea since 1998 owing to active eradication of H. pylori. Along with its decrease, the prevalence of peptic ulcer has also decreased. However, the mean age of gastric ulcer increased and this is considered to be due to increase in NSAID prescription. Gastric cancer is one of the leading causes of cancer deaths in Korea and Japan, and IARC/WHO has classified H. pylori as class one carcinogen of gastric cancer. Despite the decreasing prevalence of H. pylori infection, the total number of gastric cancer in Korea has continuously increased from 2006 to 2011. Nevertheless, the 5 year survival rate of gastric cancer patients significantly increased from 42.8% in 1993 to 67% in 2010. This increase in survival rate seems to be mainly due to early detection of gastric cancer and endoscopic mucosal dissection treatment. Based on these findings, the prevalence of peptic ulcer is expected to decrease even more with H. pylori eradication therapy and NSAID will become the main cause of peptic ulcer. Although the prevalence of gastric cancer has not changed along with decreased the prevalence of H. pylori, gastric cancer is expected to decrease in the long run with the help of eradication therapy and endoscopic treatment of precancerous lesions.

Keywords: Helicobacter, Stomach neoplasms, Peptic ulcer, Eradication therapy

References

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Fig. 1.
Trends of seroprevalence of Helicobacter pylori infection in asymptomatic subjects without a history of H. pylori eradication in 1998, 2005, and 2011 (∗p<0.05, 1998 vs. 2011). Cited from the article of Lim et al.4 (BMC Gastroenterol 2013;13:104).
kjg-65-199f1.tif
Table 1.
Total Number of Patients with Peptic Ulcer and Peptic Ulcer Related Complications5
Year Patient (n) Male Female
Peptic ulcer      
 2005 3,971,205 1,680,300 2,290,905
 2006 3,999,851 1,710,690 2,289,161
 2007 3,884,620 1,675,763 2,208,857
 2008 3,998,701 1,728,899 2,269,802
Endoscopic document peptic ulcer
 2005 1,090,745 518,090 572,655
 2007 960,317 465,601 494,716
 2008 896,976 438,801 458,175
Peptic ulcer bleeding
 2005 10,264 8,011 2,253
 2006 10,602 8,072 2,530
 2007 11,478 8,813 2,665
Peptic ulcer perforation
 2005 2,145 1,859 286
 2006 2,131 1,829 302
 2007 2,208 1,892 316
Peptic ulcer related death (bleeding)
 2005 10,136 7,829 2,307
 2007 11,136 8,481 2,655
Table 2.
Eradication of Helicobacter pylori according to Treatment Duration14
Treatment duration (day) PAC as a first line therapy
 PBMT as a second line therapy
Success, n (%) OR (95% CI) p-value Success, n (%) OR (95% CI) p-value
7 19,065/23,226 (82.1) 1   1,021/1,142 (89.4) 1  
14 5,869/6,763 (86.8) 1.43 (1.32-1.55) <0.0001 408/453 (90.1) 1.07 (0.75-1.54) 0.696
Total 24,934/29,989 (83.1)     1,429/1,595 (89.6)    

Total patient's number 32,120.

Retrospective analysis from 2001 to 2010.

P, proton pump inhibitor; A, amoxicillin; C, clarithromycin; B, bismuth; M, metronidazole; T, tetracyclin.

Table 3.
Eradication Rates of Helicobacter pylori according to Third Line Therapeutic Regimens14
Tertiary line therapy regimen Patient, n (%) Eradication rate, %
Total 141 (100) 73.8
PBMT 62 (44.0) 90.3
PAL 23 (16.3) 56.5
PAC 12 (8.5) 58.3
Others 44 (31.2) 63.6

Total number 32,120.

Retrospective analysis from 2001 to 2010.

P, proton pump inhibitor; B, bismuth; M, metronidazole; T, tetracyclin; A, amoxicillin; L, levofloxacin; C, clarithromycin.

Table 4.
Eradication Rates of Helicobacter pylori according to First Line Therapeutic Regimens14
First line therapy regimen Patient, n (%) Eradication rate, %
Total 32,120 (100) 83.2
PAC 30,565 (95.2) 83.2
PBMT 186 (0.6) 89.8
Sequential therapy 126 (0.4) 91.3
Concomitant therapy 303 (0.9) 89.8
Others 940 (2.9) 81.1

Total number 32,120.

Retrospective analysis from 2001 to 2010.

P, proton pump inhibitor; A, amoxicillin; C, clarithromycin; B, bismuth; M, metronidazole; T, tetracyclin.

Table 5.
Eradication Rates of Helicobacter pylori according to Second Line Therapeutic Regimens14
Second line therapy regimen Patient, n (%) Eradication rate, %
Total 2,056 (100) 83.5
PBMT 1,622 (78.9) 89.5
PAC 161 (7.8) 46.0
PTM 70 (3.4) 88.6
PLM 44 (2.1) 72.7
PAM 2 (0.1) 100
Others 157 (7.6) 60.5

Total number 32,120.

Retrospective analysis from 2001 to 2010.

P, proton pump inhibitor; B, bismuth; M, metronidazole; T, tetracyclin; A, amoxicillin; C, clarithromycin; L, levofloxacin.

Table 6.
Number of Newly Registered Gastric Cancer Patients in Korea17
  2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Patient (n) 23,220 23,926 23,630 26,380 26,443 26,805 28,378 30,005 30,592 31,832 30,847
Incidence rates (/100,000 person) 48.2 49.5 48.7 54.2 54.1 54.6 57.4 60.4 61.3 63.5 61.3
Table 7.
Five-Year Survival Rates (%) of Five Major Cancers in Korea17
Rank Cancer Period
 Increment
1993-1995 1996-2000 2001-2005 2006-2010
1 Thyroid cancer 94.2 94.9 98.3 99.8 5.6
2 Gastric cancer 42.8 46.6 57.7 67.0 24.2
3 Colon cancer 54.8 58.0 66.6 72.6 17.8
4 Lung cancer 11.3 12.7 16.1 19.7 8.4
5 Liver cancer 10.7 13.2 20.1 26.7 16.0
Table 8.
TNM Stage and Types of Gastric Cancer Treatment at 10 Institutes in Korea18
Stage ESD Laparoscopic surgery Open resection Robotic surgery Total
1 233 (29.9) 242 (31.0) 116 (14.9) 35 (4.5) 626 (80.3)
2 1 (0.1) 43 (5.5) 31 (3.9) 9 (1.2) 84 (10.8)
3 0 20 (2.6) 45 (5.8) 3 (0.4) 68 (8.7)
4 0 1 (0.1) 1 (0.1) 0 2 (0.3)
  234 (30) 306 (39.2) 193 (24.7) 47 (6.0) 780 (100)

Values are presented as n (%).

Period, December 2011 to July 2012; total number, 780.

ESD, endoscopic mucosal dissection.

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