Contents 01 │ Welcome Messages 02 │ Board Members 03 │ Program at a Glance 07 │ Top Abstracts Presentation 13 │ Symposium 20 │ Chairman’s Lecture 49 │ Special Lecture 71 │ Lunch Symposium 73 │ Poster 81 │ Acknowledgement 82 │ Map
Welcome Messages Dear Colleagues, On behalf of the Gastroenterological Society of Taiwan, it is my great honor and pleasure to welcome all of you participating in the 10th Asian Pacific Topic Conference (APTC) 2019, which will be held at the interventional conventional center of Kaoshiung, Taiwan from September 28 to September 29. I am very grateful to our scientiﬁc committee of TDDW for their tremendous support in organizing this program and delighted to invite gastroenterologists from Taiwan as well as delegates from all over the world to attend this wonderful meeting. The main theme of APTC 2019 is “Screening and Eradication of Helicobacter Pylori for Gastric Cancer Prevention: Current Evidence and Unresolved Issues”. The scope encompasses updated epidemiology, how to screen and treat, eﬃcacy and eﬀectiveness, how to manage after eradication, and safety and concerns of mass eradication. This professional platform will provide the optimal venue for sharing and learning cutting-edge knowledge of gastric cancer prevention from domestic and international experts. The program will also include a consensus meeting for multicenter collaboration and trials on unresolved issues. Taiwan is among the countries which have provided mass screening and eradication of H. pylori in asymptomatic subjects to prevent gastroduodenal diseases and can exchange successful experiences in this ﬁeld with other countries with high prevalence of H. pylori infection and gastric cancer. In addition to scientific program, the organizing committee has arranged social activities to enrich our network. We also hope that you will enjoy Kaoshiung which is well known as harbor city, and interesting place with a wide array of tourism and ecological resources. We also have the advantage of convenient transportation and an excellent travel environment that you will want to enjoy again and again. During such grand assembly, your active participation will be highly appreciated. All of us look forward to welcoming you in APTC 2019. Sincerely Yours!
Professor Ming-Shiang Wu, M.D., PhD. Chairman, APTC 2019 President, the Gastroenterological Society of Taiwan Distinguished Professor & Vice Superintendent National Taiwan University Hospital
Board Members Organization Committee President:
Vice Secretary General: Wei-Lun Chang Chieh-Chang Chen Mei-Jyh Chen Tsung-Hsien Chiang
Scientific Committee Chairman:
Faculty Emad El-Omar
Yeoh Khay Guan
Yong Chan Lee
Alex Hwong-Ruey Leow
The 10th Asian Pacific Topic Conference 2019 Screening and Eradication of Helicobacter Pylori for Gastric Cancer Prevention- Unresolved Problems Date：September 28, 2019（Saturday）08:30-17:40 Venue：Kaohsiung Exhibition Center, Room 301a（高雄展覽館301a會議室） Time 08:30-09:30
Top Abstracts Presentation - Part I (Joint with TDDW-UGI Section)
Epidemiology (disease burden) 09:40-10:40 Moderator: Varocha Mahachai (Thailand) Jeng-Yih Wu (Taiwan) 09:40-10:00
Updated prevalence of H. pylori infection in Asia-Paciﬁc regions (2013-2019)
Varocha Mahachai (Thailand)
Incidence of gastric cancer and prevalence of 10:00-10:20 precancerous lesions in Asia-Paciﬁc regions (2013-2019)
Alex Hwong-Ruey Leow (Malaysia)
Updated prevalence of antibiotic resistance of 10:20-10:40 H. pylori infection in Asia-Paciﬁc regions (20132019)
Yoshio Yamaoka (Japan)
11:00-11:20 Opening Ceremony (TDDW-APTC)【Room 305】 11:20-12:00 Keynote Lectures (I) (TDDW)【Room 305】
Emad El-Omar (Australia)
12:05-13:15 Lunch Symposium Chairman’s Lecture (APTC)【Room 305】 Moderator: Joseph Sung (Hong Kong) 13:20-13:50 Topic: Beneﬁcial Eﬀects of Helicobacter pylori Eradication: Beyond the Stomach
Ming-Shiang Wu (Taiwan)
How to screen H. pylori for gastric cancer prevention? 13:50-14:30 Moderator: Yoshio Yamaoka (Japan) Deng-Chyang Wu (Taiwan)
13:50-14:10 Which tests to be used for mass screening? 14:10-14:30
Deng-Chyang Wu (Taiwan)
Who needs endoscopy? The role of pepsinogen Tsung-Hsien Chiang test (Taiwan)
Special Lecture Moderator: Ming-Shiang Wu (Taiwan) 14:30-15:10 Topic: Treatment of H. pylori infection- from ﬁrst-line to third-line for gastric cancer prevention
David Graham (USA)
15:10-15:30 Coﬀee break 15:30-16:00 Chairman’s Lecture (TDDW)【Room 305】
Ming-Lung Yu (Taiwan)
Safety issues of H. pylori eradication 16:00-17:40 Moderator: Francis Mégraud (France) Jaw-Town Lin (Taiwan) 16:00-16:20
Does H. pylori eradication increase the risk and severity of gastroesophageal reﬂux disease?
Ping-I Hsu (Taiwan)
Short-term and long-term impacts of H. pylori eradication on metabolic disorders
Jyh-Ming Liou (Taiwan)
Short-term and long-term changes of antibiotic Francis Mégraud 16:40-17:10 resistance of H. pylori and other bacteria before (France) and after H. pylori eradication 17:10-17:40
Short-term and long-term changes of gut microbiota after H. pylori eradication
Emad El-Omar (Australia)
Date：September 29, 2019（Sunday）08:30-15:00 Venue：Kaohsiung Exhibition Center, Room 301a（高雄展覽館301a會議室） Time
Efficacy and cost-effectiveness of gastric cancer prevention through mass eradication of H. pylori 08:30-09:50 Moderator: Kentaro Sugano (Japan) Khean-Lee Goh (Malaysia) 08:30-08:50
Eﬀect of nation-wide H. pylori eradication in Japan
Kentaro Sugano (Japan)
Screening and eradication of H. pylori programs Yong Chan Lee in Korea (Korea)
Mass screening and eradication of H. pylori in Taiwan
Yi-Chia Lee (Taiwan)
09:30-09:50 Cost-eﬀectiveness of mass eradication
Hsiu-Chi Cheng (Taiwan)
Special Lecture Moderator: Chun-Ying Wu (Taiwan) 09:50-10:20 Topic: Recent advances in preventive and therapeutic vaccines for H. pylori
Peter Malfertheiner (Germany)
Top Abstracts Presentation- Part II (Joint with TDDW-UGI Section, Room 301b)
10:20-10:40 Coﬀee break 10:40-11:20 Keynote Lecture (II) (TDDW)【Room 305】
Chien-Jen Chen (Taiwan)
11:20-12:00 Keynote Lecture (III) (TDDW)【Room 305】
Raymond Chung (USA)
12:05-13:15 Lunch Symposium 13:10-13:20 Top Abstracts Award Endoscopic screening and management of gastric cancer precursor lesions after H. pylori eradication 13:20-15:00 Moderator: Joseph Sung (Hong Kong) Bor-Shyang Sheu (Taiwan)
New classiďŹ cation of gastritis: How to identify and classify gastric precancerous lesions?
13:40-14:00 Who needs surveillance endoscopy? How? 14:00-14:20
Genetic alterations in patients with gastric precancerous lesions
Is chemoprevention needed in patients 14:20-14:40 with extensive gastric atrophy or intestinal metaplasia? 14:40-15:00 Panel discussion
Kazunari Murakami (Japan) Bor-Shyang Sheu (Taiwan) Yeoh Khay Guan (Singapore) Chun-Ying Wu (Taiwan)
Top Abstracts Presentation Date: September 28, 2019（Saturday）08:30-09:30 Moderator: Wei-Lun Chang (Taiwan) Jiing-Chyuan Luo (Taiwan) 08:30-08:40 ESTABISH THE MIC BREAKPOINTS OF AMOXICILLIN AND
TETRACYCLINE RESISTANCE IN TRIPLE-DRUG RESISTANT H. PYLORI AS THE GUIDE OF RESCUE THERAPY Ming-Tsung Hsieh, Wei-Lun Chang, Chung-Tai Wu, Hsiao-Bai Yang, Hsin-Yu Kuo, Meng-Ying Lin, Hsiu-Chi Cheng, Yu-Chin Tsai, Bor-Shyang Sheu National Cheng Kung University, Tainan, Taiwan Background: Triple-drug resistant (TR) H. pylori that are resistant to clarithromycin, metronidazole, and levofloxacin limits the choice of effective antibiotics for eradication therapy. This study compared the treatment eﬃcacies of 2 common rescue regimens, and identiﬁed the optimal breakpoint of antibiotic resistance to predict treatment success. Patients & Methods: From February 2008 to August 2017, we consecutively enrolled 430 patients with at least one H. pylori eradication failure to receive culture for antibiotic MIC test. Seventy-three (17%) were conﬁrmed to have TR H. pylori infection. Sixty-nine recieved 1st course rescue therapy with either ATBP (amoxicillin, tetracycline, bismuth, and a proton pump inhibitor [PPI]) or MTBP (metronidazole, tetracycline, bismuth and a PPI) for 7-14 days. Forteen patients who failed 1st course therapy recieved crossover regimens in the 2nd course. Eradication result was evaluated by 13C-urea breath test. Results: The MTBP regimen had higher eradication rate than the ATBP regimen in the 1st cours therapy (intent-to-treat [ITT] analysis: 70.3 vs. 46.9%, p=0.048; per protocol [PP] analysis: 78.8% vs. 51.7%, p=0.025). For the MTBP regimen, tetracycline MIC ≦ 0.094 mg/L (p<0.001) with a 14-day treatment duration (p=0.037) was found to optimally predict eradication success with 100% accuracy. For the ATBP regimen, AMX MIC ≦ 0.032 mg/L predicted treatment success (72.2% vs. 33.3%, p=0.025). Conclusions: Optimizing the MIC breakpoints of amoxicillin and tetracycline to select a 14-day rescue regimen can improve the success of TR H. pylori eradication.
08:40-08:50 FOURTEEN-DAYS ESOMEPRAZOLE AND AMOXICILLIN
CONTAINING HIGH DOSE DUAL THERAPY ACHIEVED AN EXCELLENT ERADICATION RATE IN THE TREATMENT OF FIRST-LINE ANTI-H. PYLORI THERAPY: A PROSPECTIVE RANDOMIZED TRIAL Chih-Ming Liang1,2, Wei-Chen Tai1,2, Lung-Sheng Lu1, Pao-Yuan Huang1, Keng-Liang Wu1,2, Seng-Kee Chuah1,2 Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan1 College of Medicine, Chang Gung University, Taoyuan, Taiwan2
Introduction: The first line eradication rate of standard triple therapy for Helicobacter pylori (H. pylori) infection has declined to < 80% relate to the increasing incidence of clarithromycin-resistant strains of H. pylori and novel therapies are needed. So far, it is still unclear which one is the best ďŹ rst-line H. pylori eradication regimen with least adverse eďŹ€ects. A novel high dose dual therapy is simple and involved only two drugs and the most important of all is that amoxicillin resistance is still very low globally. The key point to success for this therapy is that high dose proton-pump inhibitors (PPI) has been used in several studies for H. pylori eradication in order to increase the intra-gastric PH for optimal eradication. However, inconsistent eradication rates were reported in the literature for high dose PPI plus amoxicillin dual therapy. A 10-day report of esomeprazole and amoxicillin containing high dose dual therapy by Zullo et al in Italy attained a near 90% eradication. Purpose: To assess the efficacy of 14-day esomeprazole and amoxicillin containing high dose dual therapy. Methods: We recruited 240 out of 278 eligible H. pylori-infected patients in the intention-to-treat (ITT analysis) after excluding those who had taken antibiotics, bismuth, PPI, within 4 weeks, were allergic to the medications used, had history of previous gastric surgery or serious concomitant illness, currently pregnant or those who refused to participate. They were randomly assigned to 14-day high-dose dual therapy (Esomeprazole 40 mg tid. and amoxicillin 750 mg qid. for 14 days, EA group, n=120) or 7-day non-bismuth quadruple therapy (Esomeprazole 40 mg bid., clarithromycin 500 mg bid., amoxicillin 1 g bid. and metronidazole 500 mg bid. for 7 days, EACM group, n=120). Eleven patients were lost during follow-up (5 in EA and 6 in EACM group, resulting in 115 for EA group and 114 in the per protocol (PP) study for EACM group. Urea breath tests were followed-up 8 weeks later.
Results: The eradication rates for EA and EACM groups were 91.7% (95% confidence interval [CI]=85.3%-96.0%) and 86.7% (95% CI= 79.3%-92.2%) (p=0.213) in ITT analysis; 95.7% (95% CI= 90.2%-98.6%) and 92.0% (95% CI=85.4%-96.3%) (p=0.255) in PP analysis. The adverse event rates were 9.6% vs. 22.8 % in the 2 groups (p=0.006). The H. pylori culture positive rate was 91.8%. The antibiotic resistance rates were amoxicillin (0%), clarithromycin (15.5%) and metronidazole (34%). The H. pylori eradication rates for patients with dual resistant to both clarithromycin and metronidazole were 100% in the EA group and only 50% in the EACM group. Conclusions: A 14-days high-dose dual therapy with esomeprazole and amoxicillin containing esomeprazole 40 mg thrice daily and amoxicillin 750 mg four times daily achieved an excellent eradication rate (95%) in the treatment of ďŹ rst-line anti-H. Pylori therapy in Taiwan with less adverse events. 08:50-09:00 COMPARISON OF EMPIRICAL 14-DAY QUADRUPLE THERAPY
A N D C U LT U R E - G U I D E D T H E R A P Y F O R T H I R D - L I N E HELICOBACTER PYLORI ERADICATION Wen-Shuo Yeh1, Chih-Ming Liang1,2, Hsin-Ming Wang1,2, Wei-Chen Tai1, Lung-Sheng Lu1, Keng-Liang Wu1, Seng-Kee Chuah1,2 Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan1 College of Medicine, Chang Gung University, Taoyuan, Taiwan2
Purpose: To assess the efficacy of amoxicillin, tetracycline, high-dose metronidazole, and a proton pump inhibitor for third-line Helicobacter pylori eradication. Patients and Methods: We enrolled 70 consecutive patients who were prospectively registered, failed to respond to two rounds of H. pylori eradication, and underwent endoscopy for H. pylori culture. Seven patients were lost to follow-up. Patients were treated according to the results of antibiotic susceptibility testing reports (cultured group, n=39). Those who failed the H. pylori culture were prescribed 14-day quadruple therapy containing esomeprazole 40 mg twice daily, amoxicillin 1 g twice daily, tetracycline 500 mg four times daily, and metronidazole 500 mg three times daily (empirical group, n=24). A follow-up urea breath test was performed 8 weeks later.
Results: The antibiotics resistance rates were as follows: clarithromycin (79.5%), levoﬂoxacin (94.9%), metronidazole (66.7%), amoxicillin (2.6%), and tetracycline (0%). The eradication rates attained by the cultured group and empirical group were 89.7% (95% conﬁdence interval [CI] = 72.72-97.11) and 58.3% (95% CI = 36.61-77.86) in per-protocol analysis (p=0.004) and 81.4% (95% CI = 66.60-91.61) and 51.8% (95% CI = 31.9-71.29) in intention-to-treat analysis (p=0.014) , respectively. Culture-guided therapy was the only clinical factor inﬂuencing the eﬃcacy of H. pylori eradication (OR: 0.16; 95% CI 0.040.60, p=0.006). Despite the high metronidazole resistance rate (66.7%) after two treatment failures, the eradication rate in patients with this condition was 84%. Conclusions: Empirical 14-day quadruple therapy is not an acceptable thirdline rescue H. pylori treatment despite the low resistance rates of amoxicillin and tetracycline. The success rate of the third-line susceptibility-guided treatment was only moderate (<90%). 09:00-09:10 CORPUS-PREDOMINANT GASTRITIS INDEX (CGI) COULD BE
REGRESSED AFTER SUCCESSFUL H. PYLORI ERADICATION AMONG H. PYLORI-INFECTED NON-ULCER DYSPEPSIA AND GASTRIC ULCER PATIENTS Hsiu-Chi Cheng1, Yu-Ching Tsai1, Chung-Tai Wu1, Er-Hsiang Yang1, Hsin-Yu Kuo1, Wei-Lun Chang1, Wei-Ying Chen1, Wei-Chun Cheng1, Hsiao-Bai Yang2, Bor-Shyang Sheu1
National Cheng Kung University, Tainan, Taiwan1 Ton‐Yen General Hospital, Hsinchu, Taiwan2 Introduction: Corpus-predominant gastritis index (CGI) can be an early marker before the occurrence of precancerous changes after H. pylori infection. The study aims to test whether CGI could be reversed after H. pylori eradication in diﬀerent surveillance periods and related to precancerous lesion progression. Methods: This longitudinal cohort study enrolled 287 H. pylori-infected nonulcer dyspepsia (NUD) or gastric ulcer (GU) subjects. CGI, Operative Link for Gastritis Assessment (OLGA), and Operative Link on Gastric Intestinal Metaplasia assessment (OLGIM) were assessed. After H. pylori eradication, subjects received surveillance endoscopy in four periods to check changes of CGI with McNemar test and OLGA/OLGIM with Wilcoxon signed-ranks test.
Results: A total of 134 (46.7%) patients had CGI at the index endoscopy. After successful H. pylori eradication, CGI had signiﬁcant regress in the 90-to-359day (positive vs. negative at surveillance, 23/68 [33.8%] vs. 45/68 [66.2%], P=0.008), 360-to-719-day (28/99 [28.3%] vs. 71/99 [71.7%], P=0.003), 720-to1439-day (13/70 [18.6%] vs. 57/70 [81.4%], P=0.001), and ≥1440-day (14/69 [20.3%] vs. 55/69 [79.7%], P=0.02). The OLGA stages were stable in the 90-to-359-day (P=0.44) and the 360-to-719-day (P=0.82), but significantly progressed in the 720-to-1439-day (20/70 [28.6%] vs. 8/70 [11.4%], P=0.005) and the ≥1440-day (17/69 [24.6%] vs. 2/69 [2.9%], P=0.02). The CGI status were not correlated with OLGA progress to stages III/IV in the 720-to-1439-day (CGI rates in OLGA progress vs. regress, 4/20 [20.0%] vs. 1/8 [12.5%], P=1.0) or the ≥1440-day (4/17 [23.5%] vs. 1/2 [50.0%], P=0.47). The OLGIM stages were not progressed in the four surveillance periods. Conclusions: Among H. pylori-infected NUD and GU patients, CGI could be signiﬁcantly regressed 90 days later after successful H. pylori eradication. More than half of the cases with CGI had regress after 2-year or longer surveillance. Even after successful H. pylori eradication, OLGA stages had signiﬁcant progress 720 days later, but irrespective of the CGI status. 09:10-09:20 LONG-TERM CHANGES OF GUT MICROBIOTA, ANTIBIOTIC
RESISTANCE, AND METABOLIC PARAMETERS AFTER HELICOBACTER PYLORI ERADICATION - A MULTICENTRE RANDOMISED TRIAL
Jyh-Ming Liou1, Chieh-Chang Chen1, Mei-Jyh Chen1, Yu-Jen Fang2, Ming-Shiang Wu1 National Taiwan University, Taipei, Taiwan1 National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan2 Introduction: We previously showed that the eradication rates of triple therapy for 14 days (T14, lansoprazole 30 mg, amoxicillin 1 g, and clarithromycin 500 mg, all given twice daily), concomitant therapy for 10 days (C10, lansoprazole 30 mg, amoxicillin 1 g, clarithromycin 500 mg, and metronidazole 500 mg, all given twice daily), and bismuth quadruple therapy for 10 days (BQ10, bismuth tripotassium dicitrate 300 mg four times a day, lansoprazole 30 mg twice daily, tetracycline 500 mg four times a day, and metronidazole 500 mg three times a day) were 83·7%, 85·9%, and 90·4% in the ﬁrst-line treatment of Helicobacter pylori (H. pylori). The short-term and long-term impacts these therapies on the gut microbiota, antibiotic resistance, and metabolic parameters were assessed in the present study.
Methods: Adult patients with documented H. pylori infection (n=1620) were randomized (1:1:1; block sizes of six) in this multicenter, open-label trial to receive T14, C10, or BQ10 using a computer-generated randomisation sequence. The long-term outcomes included reinfection rate, changes in the gut microbiota, antibiotic resistance and metabolic parameters. Fecal samples were collected before and 2 weeks, 2 months, and at least 1 year after eradication therapy. Ampliﬁcation of the V3 and V4 hypervariable regions of the 16S rRNA was done followed by high throughput sequencing. Susceptibility testing for fecal E. coli and Klebsiella pneumoniae was done. This trial is registered with ClinicalTrials.gov, number NCT01906879. Results: Compared to baseline, α-diversity was signiﬁcantly reduced 2 weeks after T14 (p=0·00017), C10 (p<0·00001), and BQ10 (p<0·00001). β-diversity was also signiﬁcantly altered 2 weeks after T14 (p=0·001), C10 (p=0·0001), and BQ10 (p=0·0001). α-diversity and β-diversity were restored at week 8 (p=0 ·14 and p=0·918, respectively) and 1 year (p=0·14 and p=0·918, respectively) after T14, but were not fully recovered at week 8 and 1 year in patients treated with C10 (p=0·00012 and p=0·0127 at week 8, respectively; p=0·019 and p=0·0643 at 1 year, respectively), and BQ10 (p<0·00001 and p=0·0002 at week 8, respectively; p=0·00097 and p=0·0286 at 1 year, respectively). The transient increase of the resistance rates of E. coli to ampicillin-sulbactam 11 ·8% (15/127) to 65·5% (38/58) for T14, 7·4% (10/135) to 63·6% (28/44) for C10, cefazolin 12·6% (16/127) to 43·1% (25/58) for T14, 9·6% (13/135) to 40 ·9% (18/44) for C10, cefmetazole 7·9% (10/127) to 25·9% (15/58) for T14, 3 ·7% (5/135) to 18·2% (8/44) for C10, levofloxacin 7·9% (10/127) to 34·5% (20/58) for T14, 7·4% (10/135) to 31·8% (14/44) for C10, gentamicin 13% (19/146) to 46·6% (27/58) for T14, 14·8% (22/149) to 45·5% (20/44) for C10, and trimethoprim-sulfamethoxazole 031·9% (48/146) to 86·2% (50/58) for T14, 28·4% (42/148) to 86·4% (38/44) for C10 after T14 and C10 at week 2 (p-values <0·05 in paired samples in the above analyses) returned to basal state at week 8 and 1 year. Although body weight and BMI slightly increased, there were signiﬁcant improvements in metabolic parameters with a decrease in insulin resistance, triglycerides and low density lipoprotein, and an increase in high density lipoprotein. Overall, there was no significant change in the prevalence of metabolic syndrome at week 8 and 1 year, after T14, C10, and BQ10. Conclusions: Eradication of H. pylori infection has minimal disruption of the microbiota, no eﬀect on antibiotic resistance of E. coli and some positive eﬀects on metabolic parameters. These collectively lend support to the longterm safety of H. pylori eradication therapy.
Epidemiology (disease burden) Date: 09:40~10:40, September 28, 2019（Saturday）
Moderator Varocha Mahachai (Thailand) Past President, Gastroenterological Association of Thailand Professor, Division of Gastroenterology, Chulalongkorn University Director, GI & Liver Center, Bangkok Hospital Medical Center, Thailand
Jeng-Yih Wu (Taiwan) Secretary of Ｈospital Medical Aﬀairs Chief of Gastroenterology Chief of Health Management Center Kaohsiung Medical University Hospital Kaohsiung Medical University, Kaohsiung, Taiwan
Varocha Mahachai (Thailand) After graduation from Chulalongkorn University in Thailand, Dr. Mahachai undertook post graduate training in internal medicine and gastroenterology at the University of Alberta, Canada and Postdoctoral Fellowship in clinical pharmacology at the University of California, San Francisco. She served as a faculty member in the Division of Gastroenterology, University of Alberta from 1985 to 1990. In 1990 she joined Chulalongkorn University where she has been actively involved in teaching, research and patient care. She served as a Chief of the Division of Gastroenterology for two terms (2004 – 2008) consecutively. Dr. Mahachai’s major research interests comprise of gastric disorders including GERD,functional GI disorders, H. pylori, UGI bleeding,mechanisms and risk factors of gastric cancer.She is also a co-investigator of many collaborative studies on H. pylori and gastric cancer risk in Asia. Dr. Mahachai serves on the editorial board of Helicobacter, and the Journal of Neurogastroenterology and Motility. She is a Past-President of the Gastroenterology Association of Thailand and has been a member of the APAGE Council members and an Editor in Chief APDNews. In addition, she is a corresponding fellow in Asia for the European Helicobacter Study Group and a member of a Healthy Stomach Initiative group. She was recently a co-chair of the joint International GAT/WGO GASTRO 2018 conference in Bangkok,Thailand which gathered over 1400 participants from over 55 countries around the world.She currently serves on the Scientiﬁc and Publication Committees of the World Gastro Organization.She has been appointed a Co-Chair of a Young Scientist Award Committee of the APAGE.
Updated prevalence of H. pylori infection in the ASEAN countries Varocha Mahachai Director, GI & Liver Center, Bangkok Hospital, Thailand
Helicobacter pylori remains a major cause of chronic gastritis, PUD and gastric cancer. Eradication therapy has clearly shown benefit in terms of symptomatic improvement in patients with chronic gastritis and reduction of PUD recurrence and reduced incidence of gastric cancer in all risk groups. The prevalence of H. pylori varies from 20% to 69% among Southeast Asian countries. Besides, it varies among regions within the same countries. The prevalence of infection also differs among different clinical presentations. The disease outcomes are determined by interaction among virulence strains of H. pylori, host genetic polymorphisms and environmental factors. The age-standardized rates of gastric cancer in Southeast Asian countries range from 3/100,000 to 23.7/100,000. The annual re-infection rates in Southeast Asian countries range from 0 â€“ 6.45%. There are no national screening program for gastric cancer in this region although most gastric cancer cases are in advance stage with very poor 5-year survival.
Alex Hwong-Ruey Leow (Malaysia) Alex Leow is the Consultant Gastroenterologist and Hepatologist in Pantai Hospital Kuala Lumpur and is Honorary Consultant Gastroenterologist and Hepatologist to University of Malaya Medical Centre, Kuala Lumpur, Malaysia. He previously worked as Associate Professor in the Department of Medicine at the University of Malaya before starting his private practice. He obtained his basic degree in Biomedical Science in 1999 at University of Malaya before furthering his study in Medicine in University College Dublin, Dublin, Ireland. He graduated in 2004 and was awarded the Penang Medical Practitioner’s Society Best All-Round Student Award. He obtained his master’s degree in Internal Medicine and was awarded the John Bosco Best Master Student Award upon graduation in 2012. His areas of interest are diagnostic and therapeutic endoscopy, Helicobacter pylori, inﬂammatory bowel disease and has authored and co-authored in numerous papers in peer-reviewed journals and presented in both local and international conferences. He is currently a member of the Asian EUS Group, Chairman of the Malaysian IBD Special Interest Group, the Secretary General of the Organising Committee of APDW 2020 and Executive Committee Member of the Malaysian Society of Gastroenterology and Hepatology.
Incidence of gastric cancer and prevalence of precancerous lesions in Asia-PaciďŹ c regions (2013-2019) Alex Hwong-Ruey Leow Consultant Gastroenterologist and Hepatologist, Pantai Hospital Kuala Lumpur, Malaysia
Gastric cancer poses a burden to patients across the globe as the third leading cause of cancer deaths worldwide and the fourth most common cancer globally. Incidence of gastric cancer is particularly high in Asian countries, which is thought to be attributed by the high prevalence of Helicobacter pylori infection. Nevertheless, there are substantial differences in incidence rates in varying geographic regions at Asia. The age standardised incidence rate for gastric cancer among males in Korea, Mongolia, Japan and China is especially high whereas gastric cancer has been low among the Malays in South East Asia. These variations may be related to differences in risk factors, such as the prevalence rate and virulence factor of H. pylori infection. The incidence rate of gastric cancer has been falling related to Helicobacter pylori eradication. Dietary, lifestyle and metabolic factors have also been implicated. A wide screening campaigns as part of national cancer screening programme were extensively performed on population in areas with high prevalence of gastric cancer; this screening policy has allowed the detection of high rates of early gastric cancer with positive impact on prognosis and mortality rates. In Japan, the rate of Early Gastric Cancer has increased from 15% a few decades ago to 50% of all endoscopically diagnosed gastric cancers at present. This together with eradication of H. pylori has rapidly changed the epidemiology of gastric cancer in Asia Pacific region. Gastric intestinal metaplasia and gastric atrophy were precancerous lesion. In a cohort study of 2,224 subjects conducted in Republic of Korea, the group with IM have 10.9-fold increased risk of gastric cancer. Therefore, each lesion of AG or IM will increase the incidence of gastric cancer, and if both lesions are combined, the incidence of gastric cancer will increase even more. Nonetheless, the natural course of these lesions and surveillance strategy in these patients remains at large debatable.
Yoshio Yamaoka (Japan) Yoshio Yamaoka, M.D., Ph.D. is currently the Chair and Professor of the Department of Environmental and Preventive Medicine at Oita University, Japan. He is also a Professor in the Department of Gastroenterology at the Baylor College of Medicine, USA. Professor Yamaoka received M.D., and Ph.D. in gastroenterology from Kyoto Prefectural University of Medicine, Japan and post graduate training in Internal Medicine and Gastroenterology from the same university. Then, he did post-doctoral work in the Department of Medicine, Section of Gastroenterology at Baylor College of Medicine before joining the faculty of the same section in 2001. Currently, he is a visiting Professor at Mongolian National University of Medical Sciences, Mongolia, an adjunct Professor at Airlangga University, Indonesia, and a Bualuang ASEAN Chair Professor at Thammasat University, Thailand. He is an Associate Editor of the Journal of Medical Microbiology, the World Journal of Gastroenterology, Gut Pathogens, PLoS ONE, Scientiﬁc Reports, and Gastroenterology Research and Practice. He is the editors of 3 international books: “Helicobacter pylori: Molecular genetics and cellular biology”, “Helicobacter pylori Research from Bench to Bedside” and “Microbiota; Current Research and Emerging Trends”. He has more than 350 International publications with impact factor more than 1,500 (Scopus; h-index 59). He is working on the mechanisms regulating the development of stomach cancer in H. pylori infection, including the discovery of novel virulence factors; OipA and DupA. He also found that H. pylori was present at least 58,000 years ago in Africa and spread into the world with changing the toxicity.
Updated prevalence of antibiotic resistance of H. pylori infection in Asia-PaciďŹ c regions (2013-2019) Yoshio Yamaoka Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas, USA
Drug resistance is recognized as one of the greatest public health threats, leading to 700,000 deaths per year worldwide. The issue is of great concern because of the rapid spread of multidrug-resistant strains, some of which may be untreatable with available treatments. In this scenario, Helicobacter pylori has emerged as an alarming bacterium due to its resistance rate, and it has been noted as one of 16 antibiotic-resistant pathogens that pose the most serious threat to human health, according to WHO. H. pylori elimination is thus one of the most effective strategies to reduce the H. pylorirelated disease burden. However, the emergence and rapid spread of drug-resistant H. pylori has become a major roadblock to eradicating the infection and a challenge for clinicians. Despite an increasing worldwide trend in antibiotic resistance, a recent meta-analysis showed that southeast Asia (10%) appeared to have low clarithromycin resistance rates compared to all WHO regions. However, the accumulated data found that there was increasing resistance to clarithromycin recently in Asia-Pacific region. Our recent study also revealed a relatively high prevalence of clarithromycin resistance (25.5%) in Cambodia. In addition, metronidazole and levofloxacin resistance rates are also increasing in Asia-Pacific region. A periodic evaluation is essential to closely monitor and control the antibiotic resistance status in the region. In this lecture, I discuss the updated prevalence of antibiotics resistance of H. pylori infection in AsiaPacific region. In addition, we discuss the reliability of genetic markers that can be used as a rapid and accurate detection test for H. pylori resistance using next-generation sequencing based approach.
Chairman’s Lecture Date: 13:20~13:50, September 28, 2019（Saturday）
Moderator Joseph Sung (Hong Kong) Mok Hing Yiu Professor of Medicine, Department of Medicine and Therapeutics; Director, Institute of Digestive Disease; Faculty of Medicine The Chinese University of Hong Kong
Ming-Shiang Wu (Taiwan) Present Position: Distinguished Professor, Department of Internal Medicine, College of Medicine, National Taiwan University Vice superintendent, National Taiwan University Hospital President, the Gastroenterological Society of Taiwan Secretary General, Taiwan Society of Internal Medicine
Bachelor of Medicine (1989) College of Medicine, National Taiwan University
Ph.D. (1998) The Graduate Institute of Clinical Medicine College of Medicine National Taiwan University Ph.D. Thesis: A study of Histopathology, Epidemiology and Genetic Alterations of Gastric Cancer
Training and academic appointment: 1990-1993
Resident in Department of Internal Medicine, National Taiwan University Hospital
Chief Resident in the same department
Research StaďŹ€ in Davison of Gastroenterology of the same department
Visiting Staff Department of Internal Medicine, College of Medicine, National Taiwan University
Outstanding Research Award, National Taiwan University Hospital
Outstanding Research Award, Professor Juei-Low Sung’s Research Foundation
Excellent Rearch Award, National Science Council
Outstanding Article Award, Taiwan Socity of Internal Medicine
Outstanding Research Article, Ming-Tsai Medical Foundation
Outstanding Young Research Award, National Science Council(吳大猷先 生紀念獎，國科會)
Outstanding Research Award, National Science Concil
Outstanding Research Award, National Taiwan University Hospial
Emerging Leader Award, Asian Paciﬁc Digestive Week
Medical Research Award, Ching-Hsin Medical Foundation
Outstanding Research Award, National Science Concil
Distinguished Professor, National Taiwan University
Academic Achievement Award, Formosa Medicial Association
Outstanding Research Award, Ministry of Science & Technology
Outstanding Service Team Award, National Taiwan University Hospital
Outstanding Research Award, Hsu Yo-Hsiung Foundation
Outstanding Research Team Award, National Taiwan University Hospital
Outstanding Teacher Award, National Taiwan University
Outstanding Research Award for improvement of population health, Wang Ming-Ning Memorial Foundation
Specialty: Gastrointestinal malignancy, Molecular Biology, Helicobacter Research interests: Gastric carcinogenesis, Helicobacter pylori-related gastroduodenal diseases Publications: More than 400 papers and 3 Book Chapters Editorial board: J Formos Med Assoc, Gut Associate editor: JGH Open
BeneďŹ cial EďŹ€ects of Helicobacter pylori Eradication: Beyond the Stomach Ming-Shiang Wu National Taiwan University Hospital, Taiwan
Helicobacter pylori are gram-negative bacteria that selectively colonize the gastric mucosa, and have been shown to be an important etiologic factor for gastroduodenal diseases, including chronic gastritis, peptic ulcer, and gastric malignancy. Ample evidence has revealed eradication of H. pylori infection can cure mucosa-associated lymphoid tissue lymphoma, reduce the recurrence of peptic ulcer and benefit a substantial portion of patients with non-ulcer dyspepsia. In addition, prevention of gastric cancer can be achieved and cost-effective by screening and eradication of H. pylori infection. Recently, the presence of H. pylori has been associated with a range of diseases beyond the stomach, such as asthma, Parkinsonism, diabetes and colon cancer. The progression from superficial gastritis to atrophic gastritis will lead to alterations not only in gastric microbiota but also gut microbiota. The changes of gut microbiota may be associated with many systemic diseases, and provide a potential mechanistic link between H. pylori infection and extra-gastric diseases. Antibiotics treatment can eradicate H. pylori infection and has a great impact in gut microbiota. Therefore, eradication of H. pylori may have beneficial effects beyond the stomach and is analogized to hit more than one bird with the same stone.
How to screen H. pylori for gastric cancer prevention? Date: 13:50~14:30, September 28, 2019ďźˆSaturdayďź‰
Moderator Yoshio Yamaoka (Japan) Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas, USA
Deng-Chyang Wu (Taiwan) Vice Superintendent, Kaohsiung Medical University Hospital Professor, Internal Medicine, Kaohsiung Medical University Chief, Department of Operation Management and Cell therapy Research Center, Kaohsiung Medical University Hospital Attending physician, Division of Gastroenterology, Department of Medicine, Kaohsiung Medical University Hospital
Deng-Chyang Wu (Taiwan) Current position: Vice Superintendent Kaohsiung Medical University Hospital Professor
Internal Medicine, Kaohsiung Medical University Chief Department of Operation Management, Kaohsiung Medical University Hospital Chief Cell therapy Research Center, Kaohsiung Medical University Hospital Attending physician Division of Gastroenterology, Department of Medicine, Kaohsiung Medical University Hospital
Education: 1977 – 1984
M.D., School of Medicine, Kaohsiung Medical College, Kaohsiung, Taiwan
1988 – 1991
M.S., Graduate Institute of Medicine, Kaohsiung Medical College, Kaohsiung, Taiwan
1992 – 2001
Ph.D., Graduate Institute of Medicine, Kaohsiung Medical University, Taiwan
2005 – 2007
M.S., Graduate Institute of Healthcare Administration, Kaohsiung Medical University, Taiwan
Experience: 1987 - 1989
Resident, Department of Internal Medicine, Kaohsiung Medical University Hospital
1989 - 1990
Chief Resident, Department of Internal Medicine, Kaohsiung Medical University Hospital
1991 - 1992
Chief of Internal Medicine, Kaohsiung Municipal Kan-San Hospital
1991 - 1999
Lecturer of Internal Medicine. Kaohsiung Medical University
1999 - 2002
Assistant professor of Internal Medicine. Kaohsiung Medical University
1995 - 1996
Research fellow, Harvard Medical School, Massachuset General Hospital GI Department, USA
2002 - 2007
Associated professor of Internal Medicine, Kaohsiung Medical University
2012 - 2015
Vice Superintendent, Kaohsiung Municipal Hsiao-Kang Hospital
2015 - 2018
Vice Superintendent, Kaohsiung Municipal Ta-Tung Hospital
Which tests to be used for mass screening? Deng-Chyang Wu Kaohsiung Medical University Hospital
H. pylori has been an important medical issue for decades. Its associations with many gastrointestinal diseases such as peptic ulcers and even gastric cancers impose a great burden on healthcare system worldwide. Consequently, population-based screening and treatment is gradually emphasized in many parts of the world, especially in east Asia, where H. pylori is prevalent. Many tests are the choices of H. pylori diagnosis. Invasive methods through endoscopic sampling such as culture, rapid urease test and histology are commonly used but are not suitable for mass screening due to its invasiveness nature. On the contrary, non-invasive diagnostic methods such as urease breath test, serology test and stool antigen test are more appropriate modalities for mass screening. These non-invasive methods yield more than 90% accuracy. Their high acceptance, satisfying diagnostic yields and high participation rates in screened population are proved in published literatures. In Taiwan experience, Matsu island has triple gastric cancer incidence than other parts of Taiwan. Mass screening of H. pylori with UBT and endoscopy were done and eradication were prescribed accordingly. The results showed 25% decline in gastric cancer incidence. Some literatures favor serology as the initial screening methods and other literatures prefer stool antigen test accompanied by stool test for colorectal cancer screening program. Through these published data and clinical experience, non-invasive methods are appropriate for mass screening. As for which non-invasive methods are more suitable, it depends on local experience, national policy, funding and budget.
Tsung-Hsien Chiang (Taiwan) EDUCATION: 2000:
M.D., College of Medicine, National Taiwan University, Taipei, Taiwan
M.Sc., Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
2014-: Ph.D.,candidate, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
HOSPITAL APPOINTMENTS: PUBLICATIONS: 1.
Chiang TH, Chuang SL, Chen SL, Chiu HM, Yen AM, Chiu SY, Fann JC, Chou CK, Lee YC, Wu MS, Chen HH. Diﬀerence in Performance of Fecal Immunochemical Tests with the Same Hemoglobin Cut-oﬀ Concentration in a Nationwide Colorectal Cancer Screening Program. Gastroenterology. 2014 Dec;147(6):1317-26.
Chiang TH, Lee YC, Liao WC, Chung JH, Chiu HM, Tu CH, Chen SC, Wu MS. Timing and Risk Factors for a Positive Fecal Immunochemical Test in Subsequent Screening for Colorectal Neoplasms. PLoS One. 2015 Sep 2;10(9):e0136890.
Lee YC, Chiang TH*, Chou CK, Tu YK, Liao WC, Wu MS, Graham DY. Association Between Helicobacter pylori Eradication and Gastric Cancer Incidence: A Systematic Review and Meta-analysis. Gastroenterology. 2016 May;150(5):1113-24. (*Equally contributed ﬁrst author).
4. Chiang TH, Chiu SY, Chen SL, Yen AM, Fann JC, Liu CY, Chou CK, Chiu HM, Shun CT, Wu MS, Lin JT, Lee YC, Chen HH, Lin MW. Serum Pepsinogen as a Predictor for Gastric Cancer Death: A 16-year Community-based Cohort Study. Journal of Clinical Gastroenterology. 2019 May/Jun;53(5):e186-e193.
Who needs endoscopy? The role of pepsinogen test Tsung-Hsien Chiang National Taiwan University Hospital
Carcinogenesis of gastric cancer follows a multistage process that develops from chronic active gastritis to atrophic gastritis, intestinal metaplasia, dysplasia, and finally to carcinoma. Although Helicobacter pylori is recognized as the main risk factor that initiates this process, irreversible mucosa damage may already have occurred in patients who have harbored H. pylori infection for decades before screening and treatment for H. pylori infection. Therefore, some patients will still need endoscopic surveillance for gastric cancer in addition to H. pylori screening. For the populationbased setting for gastric cancer prevention, the endoscopic mass screening program might be not cost-effective in regions with low to intermediate incidence of gastric cancer, and stepwise or individualized screening according to the risk stratification of gastric cancer has been recommended. Pepsinogen (PG), a proenzyme of gastric pepsin, is released into the blood as a measurable biomarker of the functional and morphologic status of the gastric mucosa. PG consists mainly of 2 subtypes: PG-I and PG-II; the former is secreted by gastric chief and mucous neck cells in the fundic glands, and the latter is secreted by cells in the pyloric and Brunner glands. When gastric mucosa become atrophic and lose the gastric glands, both the serum PG-I level and the PG-I/II ratio typically decline, and more severe atrophy is related to a lower PG-I level and PG-I/II ratio. Considering the non-invasiveness and easily interpretable characteristics, serum pepsinogen measurement has been accepted as a biomarker for atrophic gastritis prediction and has the potential as a gastric cancer screening tool.
Special Lecture Date: 14:30~15:10, September 28, 2019ďźˆSaturdayďź‰
Moderator Ming-Shiang Wu (Taiwan) Distinguished Professor, Department of Internal Medicine, College of Medicine, National Taiwan University Vice superintendent, National Taiwan University Hospital President, the Gastroenterological Society of Taiwan Secretary General, Taiwan Society of Internal Medicine
David Graham (USA) David Y. Graham, M.D. is a Professor in the Departments of Medicine and Molecular Virology and Microbiology at Baylor College of Medicine and the Michael E. DeBakey VA Medical Center in Houston. He received his undergraduate degree from the University of Notre Dame in South Bend, Indiana, his M.D. degree with honor from Baylor University College of Medicine in 1966. He board certified in Medicine and Gastroenterology. Dr. Graham is a Past President of the American College of Gastroenterology. He is currently the Editor of the journal “Helicobacter” and the author of more than 1000 scientiﬁc papers, several books, and more than 100 chapters in medical text books.. Dr. Graham has been listed as among the Top 50 Most Influential Gastroenterology Professionals of the 20th Century by Vgastroenterology.com, as one of ISI’s Highly Cited Researcher in Clinical Medicine and as one of the Best Doctors in America.
Treatment of H. pylori infection - From ďŹ rst-line to third-line for gastric cancer prevention David Y. Graham Department of Medicine, Baylor College of Medicine, Houston, TX USA.
The history of development of H. pylori therapies is one of simple trial and error with the results being judged successful if they achieved cure rates between 80 and 90%. Details of the regimes were often dictated by pharmaceutical companies based on marketing concerns rather than on ensuring reliably high treatment success. In the last 4 years, it has been universally recognized that H. pylori is an infectious disease and there has been a movement to consider the tenets of antimicrobial stewardship in designing and implementing new treatment regimens. Antimicrobial stewardship requires one to use only drugs for which the infection is susceptible and to optimize doses, formulations, dosing intervals, dosing frequency, and duration of therapy. Infectious disease therapies are expected to reliably achieve close to 100% cure rates. Comparative trials are designed as non-inferiority trials and both regimens are expected and required to achieve high cure rates. Fundamentally, all infectious disease therapies are susceptibility based. Empiric therapies are proven effective regimens given without prior susceptibility testing. When resistance arises and their success rates falter, they are abandoned as empiric regimens and only used when susceptibility is assured. The concept of first-line, second-line etc therapies now relates to cost, availability, and tolerance as all acceptable regimens are expected to have optimized cure rates for susceptible infections. The new challenge is to re-educate clinicians, investigators, and journal editors regarding what are the proven and established infectious disease treatment paradigms. Following the well-established trail blazed by the infectious disease community we can reliably cure H. pylori infections and thus eliminate H. pylori-induced diseases.
Safety issues of H. pylori eradication Date: 16:00~17:40, September 28, 2019（Saturday）
Moderator Francis Mégraud (France) Professor of Bacteriology, Laboratory of Bacteriology Bordeaux Hospital - France
Jaw-Town Lin (Taiwan) Superintendent, Digestive Medicine Center, China Medical University Hospital, Taichung, Taiwan. Chair Professor, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan. Professor Emeritus, National Taiwan University, Taipei, Taiwan Honorary President, The Digestive Endoscopy Society of Taiwan (DEST), Taipei, Taiwan. Honorary President, The Gastroenterological Society of Taiwan (GEST), Taipei, Taiwan.
Ping-I Hsu (Taiwan) Dr Hsu received his medical degree at the Taipei Medical University in 1986. He went on to complete a residency and a fellowship in gastroenterology at the National Chung Kung University in Tainan, Taiwan. In 2000, Dr Hsu took post as a research fellow at the Baylor College of Medicine in Houston, Texas. Currently, he is the Director of the Division of Gastroenterology, Kaohsiung Veterans General Hospital in Kaohsiung, Taiwan. In addition, he is also appointed as a Professor of Medicine of the National Yang-Ming University in Taipei, Taiwan. His research interests focus on the prevention and treatment of the peptic ulcer disease, gastric cancer and Helicobacter pylori (H. Pylori) infection. To date, he has authored more than 140 manuscripts, reviews and book chapters in the field of the gastroenterology and hepatology. He demonstrated that H. pylori infection is the major cause of gastric cancer in Taiwan. Additionally, he and his colleagues identiﬁed dupA gene as a novel virulent marker of H. pylori associated with an increased risk for duodenal ulcer. They also developed several novel regimens for the ﬁrst-line therapy (hybrid therapy) and rescue treatment of H. pylori infection. Recently, he showed that the proton pump inhibitor can eﬀectively reduce recurrence of peptic ulcers in clopidogrel users, and the clopidogrel users with reduced-function alleles of CYP2C19 have a higher combined cardiocerebral risk than those with full-function alleles. Dr Hsu serves as an active member of the Board of Medical Care Committee of the Gastroenterological Society of Taiwan. He has participated in many national and international research programs in gastroenterology. He serves on the reviewer boards of many prestigious scientiﬁc Journals including Gastroenterology. Dr Hsu has been invited to speak at various international and regional scientific meeting including the Digestive Disease Week of USA, UEGW and APDW. In addition, he has received many honors and awards in the academic ﬁeld. Recently he has been elected to the roster of “Top 100 Doctors in Taiwan”. In addition, he was awarded the APDW 2011 JGHF Emerging Leader Lectureship and delivered a State of Art Lecture entitled of “A New Look at Antiplatelet Agent-related Peptic Ulcer: An Update of Prevention and Treatment”.
Does H. pylori eradication increase the risk and severity of gastroesophageal reďŹ‚ux disease? Ping-I Hsu Division of Gastroenterology and Hepatology, Department of Internal Medicine; Diagnostic and Therapeutic Endoscopy Center, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung, Taiwan
Interactions between Helicobacter Pylori (H. pylori) and gastroesophageal reflux disease (GERD) are a complex issue. Depending on the type of gastritis, acid secretion of hosts may be unchanged, increase or decrease following H. pylori infection. In cases of H. pylori-related antral gastritis with gastric hyperacidity, the expectation is an improvement of reflux symptoms after eradication therapy in GERD patients. In contrast, reflux symptoms may be aggravated after eradication therapy in those who have H. pylori-related corpus gastritis and gastric hypoacidity. According to the existing data, H. pylori eradication has no significant effect on the development of GERD. Additionally, eradication therapy does not increase the risk of relapse in patients with pre-existing GERD. Currently, whether H. pylori eradication exaggerates reflux symptoms in GERD patients receiving long-term acid suppression remains controversial. A randomized controlled trial from a western population showed H. pylori eradication did not worsen reflux disease in GERD patients receiving longterm acid suppression. However, another randomized controlled trial from a Chinese population demonstrated that H. pylori eradication led to worsened control of reflux disease in patients undergoing long-term proton pump inhibitor therapy. Nonetheless, long term use of proton pump inhibitor in H. pylori-infected subjects can lead to the development of atrophic gastritis and intestinal metaplasia. H. pylori eradication is therefore recommended in GERD patients receiving long-term acid suppression therapy.
Jyh-Ming Liou (Taiwan) Dr. Jyh-Ming Liou is currently the attending physician of National Taiwan University Hospital and clinical professor of Internal Medicine at College of Medicine, National Taiwan University. He received his medical degree from National Yang-Ming University in 1998 and his Ph.D. from Graduate Institute of Epidemiology and Preventive Medicine of National Taiwan University in 2013. He completed his residency in internal medicine and fellowship in gastroenterology at the National Taiwan University Hospital in 2004. He has focused his researches in the molecular epidemiology of GI tract cancers and H. pylori infection. He has published several trials regarding the treatment of H. pylori infection in top journals, including the Lancet, Lancet Infectious Diseases, Gastroenterology, and GUT. He has received several awards, including Outstanding Research Award of National Taiwan University Hospital, Ta-You Wu Memorial Award of Ministry of Science and Technology of Taiwan, Outstanding Research Award of Ministry of Science and Technology of Taiwan, and Ching-Shing Medical Award.
Short-term and long-term impacts of H. pylori eradication on metabolic disorders Jyh-Ming Liou National Taiwan University Hospital
Helicobacter pylori (H. pylori) has been associated with obesity, metabolic syndrome, and insulin resistance in earlier observational studies. Case-control studies showed an inverse association of H. pylori and body weight. Some cohort studies showed an increase of body weight after H. pylori eradication. A randomized controlled trial also showed a trivial increase in BMI one year after H. pylori eradication. The mean BMI increased from 27.5 to 27.8 kg/m(2) and 27.0 to 27.2 kg/m(2) in the eradication group and placebo groups, respectively. The increase in body weight is probably attributed to the restoration of ghrelin secretion or the relief dyspeptic symptoms. Yet, the clinical significance of this trivial increase in body weight remains questionable. Some studies showed that insulin resistance, fasting glucose, total cholesterol, and triglyceride levels were reduced after H. pylori eradication. The changes in these metabolic parameters might be attributed to the alterations in gut microbiota. However, these findings remain controversial and further well-designed randomized trials are warranted to clarify the impact of H. pylori eradication on metabolic parameters.
Francis MĂŠgraud (France) Dr Francis MĂŠgraud is Emeritus Professor of Bacteriology at the University of Bordeaux since September 2018, He was Head of the Laboratory of Bacteriology at Hospital Pellegrin, Bordeaux, France until 2017 and he is Member of the INSERM U1053. He was Head of the INSERM U853 from 2004 to 2015. He created the National Reference Center for Campylobacters & Helicobacters in France in 1993 which he headed until 2017 and is one of the founding members and current Secretary of the European Helicobacter & Microbiota Study Group. He has been involved in the EHMSG yearly Workshops since 1988. His interest for Campylobacters & Helicobacter pylori dates back to the early days after the discovery of these bacteria. He has been involved in epidemiological studies and clinical trials of H. pylori eradication. His main current interests are the role of H. pylori in gastric cancer and antimicrobial resistance. Pubmed: 476. H index: 72.
Impact of Helicobacter pylori eradication on antibiotic resistance of bacteria Francis Mégraud INSERM U1053 & National Reference Centre for Helicobacters, Bordeaux, France
The discovery of antibiotics has been a breakthrough in the field of Medicine, by allowing for the first time in the human history to cure most if not all infectious diseases. But antibiotics have shortcomings, they are not specific to a given bacterial pathogen and can also kill bacteria other than the ‘villain’, as well as select resistant bacteria. - Impact at the individual level. After failure of a standard triple therapy, H. pylori appears resistant in about 2/3 of the cases, and the same is true for levofloxacin. The impact also exists for other bacteria of our microbiota. There are few studies on this topic but the risk is increased for H. pylori eradication by using 2 or even 3 antibiotics at the same time. Following use of standard clarithromycin based triple therapies, a dramatic increase in resistance is observed 2 weeks after the start of the treatment. After a year, the probability of persistence of resistant bacteria is still high: Streptococci (51%), Staphylococci (39%), Enterococci (14%), and Bacteroides (14%). In another study, reversion to baseline levels was observed only after 3 years. - Impact at the population level. The relationship between antibiotic resistance and antibiotic consumption in the community is more difficult to tackle. In a European study this observation was made for H. pylori where a good correlation was observed between the consumption of fluoroquinolones and macrolides and resistance to levofloxacin and clarithromycin, respectively. Similar results were observed in a Finnish study where the consumption of macrolides alone correlated with the resistance of Streptococcus pyogenes to this class of antibiotics.
Emad El-Omar (Australia) Professor El-Omar graduated in Medicine from Glasgow University, Scotland, and trained as a gastroenterologist. He worked as a Visiting Scholar/Scientist at Vanderbilt University, TN, and National Cancer Institute, MD, USA, and was Professor of Gastroenterology at Aberdeen University, Scotland, for 16 years before taking up the Chair of Medicine at St George & Sutherland Clinical School, University of New South Wales, Sydney, Australia. He is the Editor in Chief of the journal Gut. His research interests include all aspects of the microbiome, inďŹ‚ammation driven GI cancer and IBD. He is the Director of the Microbiome Research Centre at St George Hospital, Sydney.
Efficacy and cost-effectiveness of gastric cancer prevention through mass eradication of H. pylori Date: 08:30~09:50, September 29, 2019ďźˆSundayďź‰
Moderator Kentaro Sugano (Japan) Professor Emeritus, Jichi Medical University
Khean-Lee Goh (Malaysia) Emeritus Professor of Medicine at the University of Malaya, Kuala Lumpur.
Kentaro Sugano (Japan) Kentaro Sugano is a professor emeritus at Jichi Medical University since 2014. He served as the president of the Japanese Society of Gastroenterology (JSGE) from 2009 to 2014 and the president of the Organization of Japanese Digestive Disease Week (JDDW) from 2013 to 2019. He was the President of the Asian Pacific Association of Gastroenterology (APAGE) from 2014 to 2018 and was elected to be the president of Asian PaciďŹ c Digestive Week Federation (APDW) from 2018. His major research interest is upper gastrointestinal diseases including gastric cancer and Helicobacter pylori. He has been serving as an editorial board member/consultant in a number of international journals such as Gut, Gastroenterology, and Peptides. He was awarded Boas Medal from German Society of Gastroenterology, Marshall and Warren Award from the JGHF/APAGE and also from the EHMSG. He was given WGO distinguished global lecture award from WGO. He is an honorary member of Hong Kong Society of Gastroenterology, JSGE, and the Japanese Society of Internal Medicine.
Yong Chan Lee (Korea) Dr. Yong Chan Lee is a Professor of Medicine in Yonsei University, Department of Internal Medicine since 2008. He obtained his M.D. degree in 1987 and Ph.D. degree from the Department Medicine, Yonsei University College of Medicine, Korea in 1998. He played as a visiting research professor at Department of Medicine and Infectious disease, New York University School of Medicine in the Dr. Martin J. Blaserâ€™s Lab from September 2000 to August 2002. He is currently the Chief of Division of Gastroenterology, Yonsei University, College of Medicine. He is also the president of the Korean College of Helicobacter and Upper Gastrointestinal Research. His work focuses on 1) Role of H. pylori oncoprotein CagA in gastric carcinogenesis 2) Gastric cancer stem cells and their therapeutic implication 3) GI microbiota and health impacts of human gastric diseases and 4) Early endoscopic diagnosis and treatment of gastric cancer.
Screening and eradication of Helicobacter pylori (H. pylori ) in Korea Yong Chan Lee Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
Gastric cancer is the second most common cause of cancer death worldwide. Helicobacter pylori (H. pylori), the main etiologic agent for gastric cancer, induce gastric inflammation leading to atrophy and intestinal metaplasia predispose to gastric cancer development. Population based eradication of H. pylori infection is a primary prevention strategy while detection and treatment of precancerous or early stage gastric cancer is the secondary prevention strategy. At present, the secondary prevention strategy is most widely accepted strategy for gastric cancer in Korea. Until now, the Korean guideline for the diagnosis and treatment of H. pylori infection has focused on the treatment of H. pylori infection in the high risk groups. Although meta-analysis suggested effectiveness of mass eradication in decreasing gastric cancer incidence, each respective study needs to be critically evaluated to accept the soundness of the evidence. Recently published Korean studies on metachronous gastric cancer prevention have provided one of sounding evidence that this strategy may be effective, in deed. Currently, the prevention strategy of population based screening and treating H. pylori is not yet readily acceptable in Korea mainly because of paucity of data regarding costeffectiveness along with unsatisfactory eradication regimen available in Korea. The newly revised guideline, schedule to be published in 2020, may adapt these promising evidences for the screening and treatment of H. pylori infection amongst Korean population. In conclusion, we need to modify the H. pylori treatment protocols for the best cost-effective gastric cancer prevention strategy in Korea in the near future.
Yi-Chia Lee (Taiwan) University education and degrees • Bachelor of Medicine (1989-1996) College of Medicine, National Taiwan University • Master of Science (2004-2006) The Graduate Institute of Preventive Medicine, College of Public Health, National Taiwan University; title: “Primary Prevention for Gastric Cancer with Helicobacter pylori Eradication and the Cost-Eﬀectiveness Analysis” • Doctor of Philosophy (2006-2010) Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University: title: “Effect of Population-Based Screening and Treatment of Helicobacter pylori Infection on the Natural Course of Gastric Cancer and Gastroesophageal Reﬂux Disease and the Economic Evaluation”
Positions • Resident (1996-2001) Department of Internal Medicine, National Taiwan University Hospital • Attending physician (2003-now) Division of Digestive Disease, Department of Internal Medicine, National Taiwan University Hospital • Lecturer (2005-2007) College of Medicine, National Taiwan University • Clinical lecturer (2007-2008) College of Medicine, National Taiwan University • Clinical assistant professor (2008-2012) College of Medicine, National Taiwan University • Clinical associate professor (2012-2016) College of Medicine, National Taiwan University • Clinical professor (2016/8-now) College of Medicine, National Taiwan University • Jointly appointed professor (2018/8-now) Institute of Epidemiology and Preventive Medicine, National Taiwan University • Science and Education Committee, Taiwan Gastroenterology Society • Science and Education Committee, board certiﬁed endoscopist, and endoscopy mentor of The Digestive Endoscopy Society of Taiwan
Brief summary of research interest: Dr. Yi-Chia Lee is the clinical professor of Medicine in National Taiwan University, the attending physician of Internal Medicine in National Taiwan University Hospital, and the jointly appointed professor of Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University. An overriding theme throughout his researches is Population-based Screening and Prevention for Cancers in the Gastrointestinal Tract, with special emphasis on how to design, implement, and evaluate a population-based screening program that focuses on the prevention and screening of cancers in the gastrointestinal tract. Because direct beneﬁt can be derived from his researches on the population health, the impact is substantial on the society, economy, as well as the academics. Taking gastric cancer prevention as an example, starting from 2004, Dr. Lee has devoted himself to the screening and treating H. pylori infection in the population with the highest risk of gastric cancer on Matsu Island, by hypothesizing that the ameliorating inflammation of gastric mucosae could arrest carcinogenesis from chronic gastritis, atrophic gastritis, intestinal metaplasia, to gastric cancer using a quasi-experimental design of a before-and-after study and controlling for the historical eﬀect from the improved sanitation and hygiene. He also organized a research team to oﬀer active screening with C13 urea breath test for the adult population in Matsu Islands, which was collaborated with the Lienchiang Public Health Bureau, and provided endoscopic service at Lienchiang County Hospital every year. After more than one decade of follow-up, the beneﬁt of using such a strategy on gastric cancer prevention in a general population has been quantiﬁed for the ﬁrst time in the world, leading to 77.2%, 67.4%, and 25% reduction of atrophic gastritis, peptic ulcer, and gastric cancer, respectively (Gut. 2013;62:676-82). To evaluate the outcome of gastric cancer incidence, Dr. Lee further combined the results from this long-term cohort in Matsu Islands with those from randomized trials or cohort studies from China, Colombia, Finland, Japan, and Korea, to accomplished a comprehensive systematic review and meta-analysis using Poisson meta-regression models to quantify the benefit of H. pylori eradication on gastric cancer incidence (Gastroenterology. 2016;150:1113-1124.e5), which is the ﬁrst synthetic analysis to evaluate the association between H. pylori eradication and the incidence of gastric cancer across different levels of baseline gastric cancer risk and in different clinical scenarios, proves that H. pylori eradication is the level-1 evidence that can decrease the gastric cancer risk by showing that individuals with eradication of H. pylori infection had a signiﬁcant 47% gastric cancer risk reduction than those who did not receive eradication therapy. For those who retained gastric cancer risk after H. pylori eradication, the evaluation of biomarkers for selected endoscopic surveillance is ongoing.
Mass screening and eradication of H. pylori in Taiwan Yi-Chia Lee National Taiwan University College of Medicine, Taipei, Taiwan
In Taiwan, programmatic gastric cancer prevention was started in 2004 for a highrisk population residing on an offshore island (Matsu Island), applying a strategy of mass eradication of Helicobacter pylori. This prospective cohort study applied quasiexperimental, before-and-after study design, designating the whole population of Taiwan as an external comparator group. The main outcome measure was the impact of mass eradication on the changes of premalignant gastric lesions and gastric cancer, which was obtained by comparing data from the pre- and post-eradication program eras in the same population. Based on the promising results of that program over more than one decade of follow-up, the concept of this preventive strategy has been disseminated to other healthcare authorities. In Taiwan, the government has initiated a nationwide screening program for colorectal cancer using biennial fecal occult-blood test with fecal immunochemical test for adult subjects 50 to 69 years of age (extended to 50 to 74 years in June 2013). This established delivery system could be readily served as a basis for the implementation of a two-in-one, stool sample-based test panel for both colorectal cancer and gastric cancer. In 2012, a gastric cancer preventive program integrated with colorectal cancer screening has been started in a general population in Changhua County in Taiwan. After a two-year period of a feasibility study, a populationbased randomized controlled trial was conducted under the auspices of Health Promotion Administration, ministry of Health and Welfare between 2014 and 2018. Furthermore, starting in 2018, mass eradication of H. pylori has been implemented in peoples living in Indigenous Townships in Taiwan who carry the higher risk of gastric cancer than the non-Indigenous counterpart. In summary, mass screening and eradication of H. pylori has been a screening policy in Taiwan to reduce the thread of gastric cancer for populations with prevalent H. pylori infection and the higher risk of gastric cancer.
Hsiu-Chi Cheng (Taiwan) Hsiu-Chi Cheng received the M.D. degree from the School of Medicine, China Medical College, Taichung, Taiwan in 1996. He joined the Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan to receive resident training in 1997 and has been a visiting staﬀ since 2002. He has been certiﬁed as a gastroenterologist since 2003 and a digestive endoscopist since 2004. He received the Ph.D. degree from Institute of Clinical Medicine, National Cheng Kung University in 2009. He has been an Adjunct Assistant Professor since 2007 and an Associate Professor since 2014, respectively with the Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan. He has also been a tutor of the Digestive Endoscopy Society of Taiwan since 2014. His research interests include peptic ulcer bleeding disease, gastroesophageal reﬂux disorder, H. pylori related gastritis and precancerous lesions, and endoscopic diagnosis and treatment. He has papers published in scientiﬁc journals including Gut, Helicobacter, Gastrointestinal Endoscopy, Journal of Gastroenterology and Hepatology, Digestive Disease Science, Journal of Biomedical Science, and others.
Cost-eďŹ€ectiveness of mass eradication Hsiu-Chi Cheng Department of Internal Medicine and institute of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Gastric cancer is one of the top ten leading cancers in terms of incidence worldwide and leads into a large economic and expected years of life lost. Helicobacter pylori (H. pylori) is a class I carcinogen for gastric cancer and successful H. pylori eradication has the potential to prevent gastric cancer. Concerning the high prevalence and poor prognosis, the strategy of H. pylori test-and-treat to prevent gastric cancer should be important from a public health perspective. Nearly 80% of gastric cancer is H. pylorirelated; however, only 1%~4% of H. pylori-infected subjects progress to gastric cancer. Therefore, the cost-effectiveness of mass screening and eradication for H. pylori should be recognized. Systemic reviews concluded that the test-and-treat strategy for H. pylori is costeffective to prevent gastric cancer. Early H. pylori eradication once in early lifetime is cost-effective but surveillance or re-treatment strategy is not. The serology or stool antigen test is more cost-effective compared with the 13C-urea breath test. The optimal screening age depends on the population studied. In the region with low prevalence of gastric cancer, e.g., Western countries, incremental cost-effectiveness ratio (ICER) values increase as the screening starting age drops and screening at ages > 50 years old has lower ICER. However, in the region with high prevalence, e.g., Eastern Asians, the test-and-treat strategies are cost-effective when the strategies start at the age of 20 or 30 years. The reasons may be the prevalence of precancerous conditions increases with age in Eastern Asians and precancerous conditions reduce the efficacy of H. pylori eradication to prevent gastric cancer. In conclusion, the H. pylori test-and-treat strategy, usually by the serology test, has potential to be cost-effective to prevent gastric cancer, with adjustments for the age of screening depending on the population in the region with low or high prevalence of gastric cancer.
Special Lecture Date: 09:50~10:20, September 29, 2019ďźˆSundayďź‰
Moderator Chun-Ying Wu (Taiwan) Chief, Division of Translational Research, Taipei Veterans General Hospital Professor, Division of Gastroenterology& Hepatology, Taipei Veterans General Hospital Joint Appointment Researcher; National Institute of Cancer Research Adjunct Professor, Faculty of Medicine, National Yang-Ming University Editor-in-Chief, Advances in Digestive Medicine President, Taiwan Microbiota Consortium President, Society of Law and Medicine, Taiwan Supervisor, Taiwan Evidence-based Medicine Society Commissioner, Institute Review Board, National Health Research Institute Deputy Secretary General, Digestive Endoscopy Society of Taiwan Executive, Taiwan Liver Cancer Association
Peter Malfertheiner (Germany) Peter Malfertheiner is Professor of Medicine and was Chairman of the Department of Gastroenterology, Hepatology and Infectious Diseases at the Otto v. Guericke University of Magdeburg in Germany, from 1995 until 2016. He is currently leading a project on“Autonomous Aging:the role of gut microbiota”. SinceJanuary 2018 he is Professor at the LMU, University in Munich,where he works and coordinatesseveral clinical and translational research projects related to H. pylori as well as on Hepatocellular cancer He has been Professor for Internal Medicine and Gastroenterology at the University of Bonn from 1993 - 1994. He received his MD from the University of Bologna, Italy in 1975, and gained subsequent medical experience at the Regional Hospital of Bozen, Italy, and the University Hospital of Ulm, Germany (1978-1992), a Research Fellow at the Mayo Clinic GI Unit in Rochester, MN, USA. Professor Malfertheiner has been Chairman of the UEG (2004) and President of the UEGW 2006 and of the Education Committee of the United European Gastroenterology Federation (UEG). He is the Editor of Digestive Diseases, and coeditor of Gastrointestinal Tumors ,member of the Editorial Boards of several other international peer review journals. His main research interests are Helicobacter pylori infection and related diseases, chronic inﬂammation and carcinogenesis, gastric cancer, gastric and gut microbiome, hepatocellular cancer, gastroesophageal reﬂux disease (GERD). Publications (pub med) >1030.
Recent advances in preventive and therapeutic vaccines for H. pylori Peter Malfertheiner Ludwig Maximilian University , Med Klinik II , München Germany H. pylori gastritis is an infectious disease, highly prevalent in the world´s population, with often severe clinical outcomes. The infection necessitates treatment for cure of symptomatic disease and for prevention of complications. Eradication therapy of H. pylori infection is based on multi-component antibiotic therapies in combination with an acid suppressant for 10 to 14 days. There Is great concern because of an increasing failure rate of eradication therapies due to antibiotic resistance(1) . There is demand for an effective vaccine to prevent the H. pylori infection and contribute to a healthy, H. pylori free, stomach. The proof of principle for the eﬀectiveness of preventive and therapeutic vaccines of H. pylori infection has been reported in animal experiments nearly 30 years ago(2,3). It has since kept clinical scientists struggeling in their attempts to develop an effective human vaccine(4). Several vaccine constructs have been adopted, including whole bacterial cell lysates,urease, individual or multiple immunogenic epitopes and recombinant H. pylori antigens. To enforce the immunogenic response to H. pylori antigens several local mucosal or systemic adjuvants have been employed. The routes for vaccine administration have been oral, sublingual, nasal, rectal and parenteral.
Vaccines tested in humans All vaccines initially tested in humans, including urease based vaccines adjuvanted by E.coli heat labile toxin elicited modest antibody responses, but did not prove any clearance eﬀect if administered to H. pylori positive subjects. A more appropriate approach to test the eﬃcacy of a vaccine in humans made use of an H. pylori infectious challenge in healthy subjects who had previously received an investigational vaccine. The investigational vaccine used in the first study of this kind was a Salmonella vectored urease vaccine. However inspite of consistent antibody and cellular immune responses, protection from H. pylori infection has not been achieved (5). A promising and reassuring result came from a field study conducted in children in China. An orally administered urease beta subunit-based vaccine provided a signiﬁﬁcant degree of protection from H. pylori infection over a follow up period of 2 years. Unfortunately
as of to date there is no followup concerning the clinical applicabilty of this vaccine since then (6). In our personal experience we refer to a human H. pylori infectious challenge model. The vaccine construct consisted of three recombinant antigens important in H. pylori virulence, cytotoxin A (VacA), cytotoxin-associated antigen (CagA) and neutrophil-activating protein (NAP). In a phase I clinical study of safety and immunogenicity conducted in healthy subjects, the intramuscular administration of this trivalent, recombinant vaccine was safe and elicited antigen-speciďŹ c antibodies, cell-mediated immune responses, and long lasting T-cell memory (7). The encouraging findings led us to study the preventive effect of this vaccine by challenging healthy volunteers with a CagA-positive H. pylori strain. Compared to placebo the investigational vaccine did not additionally protect from the H. pylori infection challenge inspite of significant humoral and cellular immune responsiveness. The high spontaneous clearance of the H. pylori infection in young adults on placebo suggests a signiďŹ cant natural immunogenic protection in the healthy adult population (8). Several recent vaccine developments were targeting bacterial immunosuppressive molecules such as the gamma-glutamyl transpeptidase or made use of the computational approach for H. pylori antigen epitope mapping (9). Important lessons on the characteristics of the immune response following vaccine constructs tested so far will help to direct future research.This will have to include investigations on the therapeutic potential of a H. pylori vaccine.
Fallone CA, Moss SF, Malfertheiner P 2019 Reconciliation of Recent Helicobacter pylori Treatment Guidelines in a Time of Increasing Resistance to Antibiotics.. Gastroe nterologyJul;157(1):44-53.
Chen M, Lee A, Hazell S. 1992. Immunisation against gastric helicobacter infection in a mouse/Helicobacter felis model. Lancet 339:1120-1121.
Doidge C, Crust I, Lee A, et al 1994. Therapeutic immunisation against Helicobacter infection. Lancet 343:914-915.
Del Giudice G, Malfertheiner P, Rappuoli R. 2009. Development of vaccines against Helicobacter pylori. Expert Rev Vaccines 8:1037-1049.
Aebischer T, Bumann D, Epple HJ et al 2008. Correlation of T cell response and bacterial clearance in human volunteers challenged with Helicobacter pylori revealed by randomised controlled vaccination with Ty21a-based Salmonella vaccines. Gut 57:1065-1072.
Zeng M, Mao XH, Li JX, Tong WD et al. 2015. EďŹƒcacy, safety, and immunogenicity of an oral recombinant Helicobacter pylori vaccine in children in China: a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 386:1457-1464
Malfertheiner P, Schultze V, Rosenkranz B et al 2008. Safety and immunogenicity of an intramuscular Helicobacter pylori vaccine in noninfected volunteers: a phase I study. Gastroenterology 135:787-795.
Malfertheiner P, Selgrad M, Wex T et al 2018 Efficacy, immunogenicity, and safety of a parenteral vaccine against Helicobacter pylori in healthy volunteers challenged with a Cag-positive strain: a randomised, placebo-controlled phase 1/2 study. Lancet Gastroenterol Hepatol. 2018 Oct;3(10):698-707.
Sutton P, Boag JM 2018 Status of vaccine research and development for Helicobacter pylori Vaccine. 2018 Apr 4. pii: S0264-410X(18)30017-3. doi: 10.1016/j .
Top Abstracts Presentation – Part II Date: 09:00~09:50, September 29, 2019（Sunday） Venue: Kaohsiung Exhibition Center, Room 301b（高雄展覽館301b會議室） 09:00-09:10 LEVOFLOXACIN SEQUENTIAL THERAPY VERSUS BISMUTH
QUADRUPLE THERAPY IN THE SECOND-LINE AND THIRD-LINE TREATMENT OF HELICOBACTER PYLORI – A MULTICENTER RANDOMIZED TRIAL Jyh-Ming Liou1, Yu-Jen Fang2, Po-Yueh Chen3, Chieh-Chang Chen1, Ming-Jong Bair4, Ming-Shiang Wu1
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan1 Department of Internal Medicine, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan2 Department of Internal Medicine, Chia-Yi Christian Hospital, Chiayi, Taiwan3 Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taitung, Taiwan and Mackay Medical College, New Taipei City, Taiwan4 Background: The eﬃcacy of levoﬂoxacin-based triple therapy is lower than 80% in the second-line treatment of Helicobacter pylori (H. pylori) infection. Our recent trial showed that levofloxacin-based sequential therapy was superior to levoﬂoxacin-based triple therapy in the second-line treatment of H. pylori. Aims: We aimed to compare the efficacy and safety of 14-day levofloxacin sequential therapy versus 10-day bismuth quadruple therapy in the secondline and third-line treatment of H. pylori infection. Methods: H. pylori infected patients who failed after one treatment were eligible in this open labeled, multicenter, randomized trial, and were randomized to receive (1) levofloxacin sequential therapy (EAML): esomeprazole 40 mg and amoxicillin 1 g for the first 7 days, followed by esomeprazole 40 mg, metronidazole 500 mg, and levoﬂoxacin 250 mg for another 7 days (all twice daily); or (2) bismuth quadruple therapy (BQ): esomeprazole 40 mg twice daily, bismuth tripotassium dicitrate 300 mg four times a day, tetracycline 500 mg four times a day, and metronidazole 500 mg three times a day, for 10 days. The primary end point was the eradication rate in the second-line treatment according to intention to treat (ITT) analysis. The minimum inhibitory concentrations were determined by agar dilution test.
Results: A total of 560 patients have been recruited and results were available for analysis in 533 patients up to Jan 2019. The demographic characteristics and antibiotic resistance rates were similar across the two treatment groups. The eradication rate in the second line treatment were 88.3% (235/266) and 88.4% (236/267) in the levoﬂoxacin sequential therapy and bismuth quadruple therapy groups, respectively (p=1.000) in the ITT analysis. The eradication rates were 89.7% (235/262) and 92.9% (236/254) in the levofloxacin sequential therapy and bismuth quadruple therapy according to PP analyses, respectively (p=0.195). The eﬃcacy of levoﬂoxacin sequential therapy, but not bismuth quadruple therapy, appeared to be aﬀected by levoﬂoxacin resistance. The frequency of any adverse effects was higher in patients treated with bismuth quadruple therapy than levofloxacin sequential therapy (76.4% vs. 44.1%, p＜0.001). Conclusions: Levoﬂoxacin sequential therapy and bismuth quadruple therapy are similarly eﬀective in the second-line treatment for H. pylori infection (Trial registration number: NCT NCT03148366). 09:10-09:20 PROBIOTICS-CONTAINING YOGURT INGESTION AND H. PYLORI
ERADICATION CAN RESTORE FECAL FAECALIBACTERIUM PRAUSNITZII DYSBIOSIS IN H. PYLORI-INFECTED CHILDREN
Yao-Jong Yang1,2, Peng-Chieh Chen2, Fu-Ping Lai1, Bor-Shyang Sheu2,3 Departments of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan1 Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan2 Departments of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan3 Background: H. pylori infection can alter the diversity and richness of gut microbiota, and probiotics ingestion can improve H. pylori-induced gastric and systemic inﬂammation in vivo and in vitro. Aims: To investigate the compositional diﬀerences in fecal microbiota between children with and without H. pylori infection, and to test whether probioticscontaining yogurt and H. pylori eradication can improve dysbiosis in children. Methods: Ten H. pylori-infected children and 10 age- and sex-matched controls were enrolled to ingest probiotics-containing yogurt for 4 weeks. Ten-day triple therapy plus yogurt was given to the H. pylori-infected children on the 4th week. Fecal samples were collected at enrollment, after yogurt ingestion, and 4 weeks after successful H. pylori eradication. Fecal secretory immunoglobulin A and cytokines were measured by ELISA. The composition of fecal microbiota was checked through metagenomic sequencing of the V4 region of the 16S rRNA gene. The OTUs demonstrating major changes in relative abundance were identiﬁed by LEfSe and Metastats.
Results: On average, 1.6 M reads were obtained for each of the 37 fecal samples. The sequences were aligned and clustered into 295 OTUs. The H. pylori-infected children had higher levels of transforming growth factor-beta1 in the fecal samples than those who were not infected (P = 0.02). We identiﬁed eight significantly altered OTUs in the H. pylori-infected children. Among them, the abundance of Faecalibacterium prausnitzii was significantly lower in the H. pylori-infected children and then increased after yogurt ingestion and successful eradication of H. pylori (P ＜ 0.05). Pretreatment with F. prausnitzii supernatant signiﬁcantly ameliorated lipopolysaccharide-induced IL-8 in HT-29 cells. Conclusions: Probiotics-containing yogurt ingestion and H. pylori eradication can restore the decrease of fecal F. prausnitzii in H. pylori-infected children. 09:20-09:30 RISK FACTORS OF MUCOSAL BREAK IN LOW-DOSE ASPIRIN
USERS WITH SECOND PREVENTION OF GASTROINTESTINAL INJURY BY ACID INHIBITORS
Zhi-Fu Tseng1,2, Sung-Shuo Kao1, Feng-Woei Tsay1, Jin-Shiung Cheng1, Wen-Chi Chen1, Ping-I Hsu1,2 Division of Gastroenterology and Hepatology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan1 Diagnostic and Therapeutic Endoscopy Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan2 Background: Low-dose aspirin (75-325 mg/day) is widely used in the prevention of myocardial infarction or ischemic stroke. However, use of aspirin is associated with an increased risk of gastrointestinal injury including erosion, ulcer and ulcer bleeding. Aims: To investigate the risk factors of gastroduodenal mucosal break in lowdose aspirin users with second prevention of gastrointestinal injury by acid inhibitors. Methods: Long-termed low-dose aspirin users with atherosclerotic diseases and peptic ulcer history who did not have peptic ulcers or erosions at initial endoscopy were randomly assigned to receive either famotidine (20 mg bid) or omeprazole (20 mg qd) for 24 weeks. Follow-up endoscopy was conducted at the end of week 24 and whenever bothersome dyspeptic symptoms, hematemesis or tarry stool developed. The major outcome measure was gastroduodenal mucosal break (erosion/ulcer). Multivariate analysis was conducted to search the risk factors of mucosal breaks.
Results: From Nov 2013 to June 2018, 250 patients were randomly to receive either famotidine (n = 122) or omeprazole (n = 128). The incidence of gastroduodenal mucosal break during the 24-week period was 32.1% in famotidine group and 18.6% in omeprazole group. The latter had a lower incidence of mucosal break than the former (95% conﬁdence interval: -24.25% - -2.8% ). Univariate analysis revealed that omeprazole use was associated with a lower risk of mucosal break (P = 0.042), and smoking was associated with an increased risk of mucosal break (55.6% vs 21.7%; P =0.013). Multivariate analysis showed that omeprazole use was an independent protective factor (odds rate: 0.46; 95% CI:0.22 - 0.96; P = 0.038), and smoking was a risk factor of mucosal break (odds rate: 3.03; 95% CI: 1.26 - 7.26; P = 0.013) Conclusions: In low-dose aspirin users with second prevention of gastrointestinal injury by acid inhibitors, proton pump inhibitor is more eﬀective than histamine-2 receptor antagonist. Smoking is an independent risk factor of the development of mucosal break in patients with secondary prevention of gastrointestinal injury by low-dose aspirin. 09:30-09:40 A CLINICAL PERFORMANCE STUDY COMPARING THE
VSTRIP ® HELICOBACTER PYLORI ANTIGEN RAPID TEST AND IMMUNOCARD STAT!® HPSA FOR THE DETECTION OF HELICOBACTER PYLORI IN STOOL SAMPLES COLLECTED F R O M PAT I E N T S W I T H U P P E R G A S T R O I N T E S T I N A L COMPLAINTS OR VOLUNTEERS FROM THE GENERAL POPULATION
Yu-Jen Fang1, Chieh-Chang Chen1,2, Ji-Yuh Lee1, Ming-Shiang Wu2, Jiing-Chyuan Luo3, Jyh-Ming Liou2 Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, College of Medicine, National Taiwan University Yunlin, Taiwan1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan2 Department of Medicine, National Yang-Ming University, School of Medicine and Taipei Veterans General Hospital, Taipei, Taiwan3 Background: Vstrip® Helicobacter pylori Antigen Rapid which is an in-vitro diagnostic medical devise (IVDD) to perform rapid immunochromatographic assay that can quickly detect H. pylori antigens in stool samples to ascertain the presence of H. pylori infection.
Aims: This open-label, cross-sectional, multiple-center clinical performance study aimed to compare the Vstrip® H. pylori Antigen Rapid Test with the US FDA-approved ImmunoCard STAT!® HpSA test for substantial equivalence in detecting H. pylori in stool samples, as based on validated detection results derived via the urea breath test (UBT). Methods: A total of 352 adult subjects were recruited. Stool samples were collected for Vstrip® H. pylori Antigen Rapid Test, ImmunoCard STAT!® HpSA test and Premier Platinum HpSA® PLUS. 13C-Urea Breath Test (13C-UBT) was used as the gold standard test. All subjects who have completed the stool sample collections were included in the ITT analysis. The sensitivity, speciﬁcity, and positive and negative likelihood ratios for the investigational devices were determined with reference to the results of the UBT validation. Results: The prevalence of H. pylori infection was 22.4% (79/352, 95% CI 18.3-27%) in this study population. The sensitivity of the Vstrip® HpSA and ImmunoCard STAT!® HpSA tests were 91% (72/79, 95% CI 82-96%) and 77.2% (61/79, 95% CI 66-86%), respectively. The specificity of the Vstrip® HpSA and ImmunoCard STAT!® HpSA tests were 97% (265/273, 95% CI 94.198.6%) and 97% (265/273, 95% CI 94.1-98.6%), respectively. The accuracy of the Vstrip® HpSA and ImmunoCard STAT!® HpSA tests were 95% (335/352, 95% CI 92-97%) and 92% (326/352, 95% CI 89-95%), respectively. Conclusions: The Vstrip ® HpSA has equivalent performance as the ImmunoCard STAT!® HpSA, and has the potential to become a self-testing in vitro diagnostic medical device. 09:40-09:50 MATERNAL HELICOBACTER PYLORI-SEROPOSITIVE IS
ASSOCIATED WITH GESTATIONAL HYPERTENSION BUT IRRELEVANT TO GROWTH AND DEVELOPMENT OF EARLY CHILDHOOD
Shu-Han Kuo1, Fu-Ping Lai1, Yi-Fang Tu1,2, Bor-Shyang Sheu1,3, Yao-Jong Yang1,2 Departments of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan1 Departments of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan2 Institutes of Clinical Medicine, National Cheng Kung University Hospital, Tainan, Taiwan3 Background: H. pylori infection during pregnancy is related to several adverse outcomes in both mothers and neonates. However, maternal H. pylori infection impacts on the growth and neurodevelopment potential of the fetus remained controversial.
Aims: The aim of this study was to explore the inﬂuences of maternal H. pylori infection on pregnancy-related adverse events, cord blood levels of growthrelated hormones, fetal growth, and early childhood development. Methods: The prospective cohort study recruited singleton pregnant women without major medical illnesses from January 2014 to January 2015. Demographic data for the cohort and medical issues related to pregnancy were recorded. The seropositivity of H. pylori is defined as ＞ 12 U/ml of anti-H. pylori IgG in maternal serum. Cord blood levels of insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3), insulin, and ghrelin were determined using ELISA. Eligible newborns were monitored for growth for up to 3 years each year, and the cognitive development was evaluated using the comprehensive developmental inventory for infants and toddlers (CDIIT) test at 3 years of age. Results: Of the 106 enrolled women, 25 (23.6%) were H. pylori-seropositive. Maternal H. pylori seropositivity was associated with a higher risk of developing gestational hypertension (GH) (12% vs. 1.2%, p=0.04) and lower cord blood levels of IGF-1 (＜35 ng/ml, 70.0% vs. 40.7%, p=0.02) and IGFBP-3 (＜1120 ng/ml, 100.0% vs. 76.3%, p=0.02) compared with the seronegative women. No signiﬁcant impact on birth weight, childhood growth and cognitive development was found to be associated with maternal H. pylori seropositivity during pregnancy. Conclusions: Maternal H. pylori infection during pregnancy was more likely to develop gestational hypertension, but not correlated with the growth and development of fetus and childhood. In addition to close monitoring of hypertension, H. pylori eradication can be considered for such H. pyloriinfected mothers.
Endoscopic screening and management of gastric cancer precursor lesions after H. pylori eradication Date: 13:20~15:00, September 29, 2019ďźˆSundayďź‰
Moderator Joseph Sung (Hong Kong) Mok Hing Yiu Professor of Medicine, Department of Medicine and Therapeutics; Director, Institute of Digestive Disease; Faculty of Medicine The Chinese University of Hong Kong
Bor-Shyang Sheu (Taiwan) Distinguished Professor of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Kazunari Murakami (Japan) Professor and Chairman, Department of Gastroenterology and Endoscopy Center, Oita University Faculty of Medicine
Faculty Appointment 2013-
Professor and Chairman, Dept. of Gastroenterology and Endoscopy center
Clinical Professor, Dept. of Gastroenterology
Associate Professor, Dept. of Gastroenterology
Assistant Professor, 2nd Dept. of Internal Medicine
Assistant Fellow, 2nd Dept. of Internal Medicine, Oita Medical University
Hiroshima University School of Medicine, Hiroshima (M.D.)
Graduate School of Medicine, Oita Medical University (Ph.D.)
2nd Dept. of Internal Medicine, Oita Medical University
Fellowship: 1996 â€“ 1997
Postdoctoral Fellow, Tissue Typing Laboratory, University of California, Los Angeles (UCLA), LA, USA
Memberships: Fellow, American college of Gastroenterology Councilor, Japanese Society of Gastroenterology Councilor, Japanese Society of Gastroenterological Endoscopy Councilor & Secretary, The Japanese Society for Helicobacter Research Councilor, Japanese Gastroenterological Association
CertiďŹ ed Physician, The Japanese Society of Internal Medicine The Japanese Association for Infectious Disease Japanese Society of Chemotherapy Japan Pancreas Society Japan Biliary Association The Japanese Society of General Medicine
Major Research Interests:
Clinical Microbiology of Helicobacter pylori infection
Endoscopic surgery for Gastrointestinal Tract
New classiďŹ cation of gastritis: How to identify and classify gastric precancerous lesions? - Gastric cancer risk assessment by Kyoto classiďŹ cation of gastritis Kazunari Murakami Department of Gastroenterology, Oita University, Faculty of Medicine, Oita, Japan
Over the past few years, the profile of Helicobacter pylori infection has changed in Japan. In particular, the relationship between H. pylori and gastric cancer has been demonstrated more clearly. In 2016, the committee of the Japanese Society for Helicobacter Research has revised the guidelines for diagnosis and treatment of H. pylori infection in Japan. In 2013, Treatments for H. pylori-associated gastritis was covered by health insurance. In fact, all H. pylori-infected patients in Japan can receive these insurance-covered combination therapies for the eradication. Before diagnosing and treating H. pylori infection, an endoscopic examination is required to obtain a definitive diagnosis of H. pylori gastritis. In 2014, first version of Kyoto classification of gastritis was published, and in 2018, it was revised. Successful eradication of H. pylori improves histological gastritis and may prevent various diseases associated with H. pylori infection, such as gastric cancer. It is necessary to evaluate the risk of gastric cancer by endoscopic findings, and also necessary to make a long follow-up after the eradication. Especially for atrophic gastritis, intestinal metaplasia, enlarged fold, and nodular gastritis, which are considered as being in a high-risk group of gastric cancer, and endoscopic diagnosis of them is undeniably required. Improvements of them after the eradication may be regarded as one reason for prevention of gastric cancer. We also attempt to score for these findings according to the grades of the lesions.
Bor-Shyang Sheu (Taiwan) Current position: • Distinguished Professor of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan 2007-now
Experience: • Superintendent of Tainan Hospital, Ministry of Health & Wealth, Taiwan 2016-2019 • Deupty Superintendent, National Cheng Kung University Hospital, Tainan, Taiwan 20112015. • Chairman, Internal Medicine Committee, Ministry of Science & Technology, Taiwan 2011-2013. • Professor, Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan 2004-2007
Expert ﬁelds: Prof. Sheu is an expert in Gastroenterology, Microbiology, and Immunology. He has published more than 270 SCI articles, and graduate for 16 pHD students, and 39 Master degree students. Prof. Sheu has in major focused on Helicobacter pylori infection, virulence factor and genomic host factor related to the gastric carcinogenesis. Prof. Sheu also focus on the early precancerous lesion detection and chemoprevention in H. pylorirelated diseases. Prof. Sheu is also expert in the epigenetic microRNA as biomarker for the screening and surveillance to the gastric precancerous changes as SPEM & IM. As well, Prof. Sheu has devoted to clnical intervention with probiotics to regulate microbiota to improve the control of gastrointestinal diseases.
Honors & Awards: • 1997 European H. pylori study group 14th international workshops of H. pylori and gastroduodenal pathology, Young Scientist Award (YSA), Spain • 1999 Award of Career Develop Grant (CDG) of National Research Institute (NHRI), Taiwan • 2000 Prof. Sung Jui-Rong’s Research Awards of Gastroenterology, Taiwan • 2003-2006 Outstanding Research Award (ORA) of National scientiﬁc council, Taiwan
• 2007-now Distinguished Professor of National Cheng Kung University, Tainan, Taiwan • 2009 Emerging Leader Lectureship Award of Asia Paciﬁc Digestive Disease Week • 2012 Award Innovate Research Grant (IRG) of National Research Institute (NHRI), Taiwan • 2016 Best research article award of GEST, Taiwan • 2017 Top-Research Article Award of National Cheng Kung University, Taiwan • 2018 Outstanding Research Award (ORA), Ministry of Science and Technology (MOST), Taiwan
Editorial review for SCI journal: • Associate editor of BMC Microbiology (2010 up to now) • Editorial Boards of SCI journals (Am J Gastroenterol, Aliment Pharmacol Ther, J Gastroenterol Hepatol, World J Gastroenterol, World J Gastrointest Endosc, Advanced in Digestive Med, J Biomed Sci, The Sci World J) • Peer referees for more than 250 times (including Lancet, Lancet infect Dis, Lancet Oncol, Gastroenterology, Gut, Hepatology, Am J Gastroenterol, Aliment Pharmacol Ther, J Gastroenterol Hepatol, Cancer Res, Clin Cancer Res, Helicobacter, Intl J Cancer, Cancer, Endocopy, BMC Gastroenterol, Gastrointest Endosc, Dig Dis Sci, J Clin Gastroenterol, AIDM, Journal of Biomed Sci, JFMA, Am J Clin Nutrit, Am J Kideny Dis, Oncotarget, PLoS One, Br Med J, JAMA, Medicine, etc.)
Who need surveillance endoscopy ? How ? Bor-Shyang Sheu Distinguished Professor Department of Internal Medicine, Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan
H. pylori is the type I WHO gastric cancer carcinogen. Following to the Correaâ€™s cascade, subjects with certain genomic predispositions and/or infected with more virulent H. pylori isolates have increased risk to have gastric precancerous lesions as atrophy/intestinal metaplasia and gastric cancer. Eradication of H. pylori infection is currently proven as cost-benefit modality to improve gastric cancer control in general population, including to decrease the development of gastric cancer and to prevent the progression of gastric precancerous atrophy and intestinal metaplasia. The role of gastric endoscopy for specific riksy group after mass screening H. pylori infection can confirm the clinical disease phenotype, and offer the topographic samplings of gastric specimens to define the severity and distribution of gastritis and precancerous lesions, currently suggested by OLGA/ OLGIM, etc. There has been validated with some potential markers as CGI/ SPEM even earlier than OLGA/OLGIM to improve the earlier identification of risky group of gastric cancer. The longitudinal surveillance to the risky group can be suggested to those with advanced age (A), blood (B) level of pepsinogen I/II < 3, history (H) to have gastric cancer or endoscopic resection to early gastric cancer, and those with precancerous (P) lesions in an advanced stages, such as OLGA/OLGIM III-IV. The endoscopic longitudinal surveillance timings can be following to 2019 MAP-2 consensus, including 1> within 6 to 12 months for cases with low or high grade gastric dysplasia; 2 > per 3 years for cases with precancerous lesions in advanced OLGA/OLGIM stages III-IV; 3 > longer follow up period > 3 years or even not suggested for cases with precancerous lesion only confined to gastric antrum as with low OLGA/OLGIM stages. Such a strategy of surveillance interval by endoscopy for precancerous lesions after H. pylori eradication is now illustrated with cost-benefit worldwide. In future, further precise risk stratifications for age, blood test with new biomarkers, history, and certain new earlier pathological precancerous lesion as CGI/ SPEM shall be promising in need to conduct an earlier surveillance endoscopy to control the gastric cancer.
Khay-Guan Yeoh (Singapore) MBBS (NUS), MMed (Int Med), FRCP, FRCP (Glasg) FAMS. Deputy Chief Executive, National University Health System Lead Principal Investigator, Singapore Gastric Cancer Consortium Dr Khay-Guan YEOH is Deputy Chief Executive, National University Health System and faculty member of the National University of Singapore. He practices as a Senior Consultant at the Division of Gastroenterology and Hepatology, National University Hospital (NUH). As Deputy Chief Executive, he oversees clinical care planning and health system transformation for the National University Health System. He served as Dean of the NUS School of Medicine from 2011 to 2018. Dr Yeohâ€˜s research interest is in enhancing the early detection of gastric and colorectal cancers. He is the Lead Principal Investigator of the Singapore Gastric Cancer Consortium, a national ďŹ‚agship research group, and chairs the National Colorectal Cancer Screening Committee of the Health Promotion Board, Ministry of Health. He has published over 170 peer-reviewed papers in international journals, 9 book chapters and has an H-index of 50 with over 7,700 citations. He was awarded the National Medical Excellence Award as Outstanding Clinician Scientist by the Ministry of Health, Singapore in 2013.
Whatâ€™s the role of molecular markers in the risk stratiďŹ cation of future gastric cancer risk after H. pylori eradication? Khay-Guan Yeoh Department of Medicine, National University of Singapore Lead Principal Investigator, Singapore Gastric Cancer Consortium Deputy Chief Executive, National University Health System
Even after treatment for eradication of Helicobacter pylori, patients may remain at risk of future gastric cancer (GC) due to the presence of pre-neoplastic lesions such as atrophic gastritis, intestinal metaplasia (IM) and dysplasia. The residual risk is in the order of 21-128 per 100,000 person-years, however the risk for an individual is highly variable depending on pre-existing histology and genetic factors. Risk stratification will therefore be clinically very useful if an appropriate method were available, in order to identify those with the highest risk for follow-up. Molecular markers which mark genetic and epigenetic alterations of significance in gastric carcinogenesis may be useful in risk stratification after H. pylori eradication. DNA methylation is a key epigenetic modification, and accumulation of aberrant DNA methylation, resulting in an epigenetic field defect, has been shown to be associated with GC risk. DNA methylation markers such as miR-124a-3 have been shown to exhibit good odds ratios and performance (AUC) in case-control studies. A nationwide, prospective multicenter cohort study for GC risk prediction in 2,000 H. pylori eradicated healthy individuals is in progress in Japan (UMIN000016894). To examine the genomic landscape of IM in gastric carcinogenesis, a prospective predisease high-risk cohort (Gastric Cancer Epidemiology Programme, GCEP) comprising 2,980 subjects age > 50 years (mean age 59Âą7 years) was enrolled, and 5 years of surveillance was completed in 2016. Twenty-one early gastric neoplasia (EGN), defined as high grade dysplasia, carcinoma in-situ or adenocarcinoma, were detected during surveillance. Comprehensive genomic profiling using next generation sequencing (NGS) to characterize IM biopsies was performed, and 3 genomic alterations which showed associations with disease progression of IM to EGN were identified. A customized molecular test to identify this high-risk subset of IM patients for targeted endoscopic surveillance is being developed, and will be validated in an international, prospective multicenter cohort study.
Chun-Ying Wu (Taiwan) MD, PhD, MPH, LLM, LLB Director, Institute of Biomedical Informatics, NYMU Chief, Division of Translational Research and Excellence Cancer Research Center, TVGH President, Taiwan Microbiota Consortium In medical research career, Chun-Ying Wu received his M.D. degree from National Taiwan University (NTU) in 1991, M.P.H. degree from Harvard School of Public Health in 1993, and Ph.D. degree from NTU in 2007. Prof. Wu has positions as the Director of Biomedical Informatics of National Yang-Ming University (NYMU) and Chief of Translational Research and Excellence Cancer Research Center, Professor of Gastroenterology in Taipei Veterans General Hospital (TVGH), and also Joint Appointment Researcher of National Institute of Cancer Research. Prof. Wu establishes Taiwan Microbiome Consortium and currently serves as the ﬁrst President in the consortium. Prof. Wu is now the Editor-in-Chief of Advances in Digestive Medicine, associate editor of Journal of Gastroenterology and Hepatology, and editorial member of Gut, the executive of the Taiwan Liver Cancer Association, and the Taiwan Evidence-based Medicine Association. Prof. Wu has published many articles in top ranking journals such as JAMA, J Clinical Oncology, JAMA Intern Med, Gastroenterology, Gut, J of Hepatology, Hepatology, Annals of Surgery, Gastrointest Endoscopy, Biosens Bioelectron, etc. Prof. Wu owns several patents, such gastric cancer screening, hepatitis B virus quantitative detection methods, microbiota to treat metabolic syndrome, etc. Prof. Wu is the winner of 2018 Taiwan Medical Model Award, 2016 National Innovation Award, 2015 Outstanding Research Award, and 2015 Asia-Paciﬁc Emerging Leadership Award, and also 2013 Best Teaching Awards. Prof. Wu is also very active in legal societies. He received his LL.B. degree from Tunghai University (TU) in 2000 and LL.M. degree from Harvard Law School in 2003. He severed as the President of Taiwan Society of Law and Medicine between 2016-2018, and Professor of Law in College of Law at the TU. He is also the member of Medical Dispute Assessment Committee of Ministry of Health and Welfare (MOHW), the member of Institute Review Board of the National Health Research Institutes (NHRI), the member of the Ethical Committee of many central governments’ departments, including MOHW and NHRI. His legal research interests include medical malpractice litigation and biotechnology regulation. Prof. Wu has published four law textbooks, four chapters in law books, and more than 60 articles in peer-reviewed journals. Prof. Wu’s evidence-based research has become the important basis of many Taiwan’s nationwide policies regarding medical malpractice.
Is chemoprevention needed in patients with extensive gastric atrophic or intestinal metaplasia Chun-Ying Wu Institute of Biomedical Informatics, National Yang-Ming University Division of Translational Research, Taipei Veterans General Hospital
Gastric atrophic gastritis (AG) and intestinal metaplasia (IM) are the pre-cancerous lesions for gastric cancer. Previous studies have suggested the efficacy of Helicobacter pylori eradication to reduce the risk of IM progression and gastric cancer development. Therefore, AG and IM have been listed as the indications to eradicate H. pylori infection. In addition to H. pylori eradication, do we need other chemopreventive measures, such as non-steroidal anti-inflammatory drugs (NSAIDs) to prevent gastric cancer in patients with AG or IM? The necessity of chemoprevention depends on the risk of gastric cancer in patients with AG and IM. In a nationwide cohort study conducted in Netherlands, the annual incidence of gastric cancer among patients with IM was 0.2%. In a large cohort longterm study based on 7,059 patients in Taiwan, we found the 5-, 10-, and 15-year cumulative incidences of gastric cancer in patients with IM were 0.9%, 2.0%, and 3.0%, respectively. Compared with the risk in the general population, the SIRs for non-dysplasia, low-grade dysplasia and high-grade dysplasia were 2.0, 7,8 and 35.2, respectively. According to the long-term cohort study, we suggest chemoprevention (not including H. pylori eradication) may be helpful to reduce gastric cancer risk in those with low-grade or high-grade dysplasia. However, more large-scale long-term studies will be necessary to confirm these suggestions.
Lunch Symposium Optimizing Current Treatment in Acid Related Diseases Date: 12:05~13:15, September 28, 2019（Saturday） Time
Ming-Shiang Wu (Taiwan)
New advances in the treatment of GERD
Chi-Yang Chang (Taiwan)
Jiing-Chyuan Luo (Taiwan)
Optimization of Helicobacter pylor therapy
David Graham (USA)
Jyh-Ming Liou (Taiwan)
Lunch Symposium Application of Helicobacter pylori stool antigen test for gastric cancer prevention Date: 12:05~13:15, September 29, 2019（Sunday） Time
Jyh-Ming Liou (Taiwan) Ching Sui A. Yi (Taiwan)
Peter Malfertheiner (Germany)
Application of Helicobacter pylori stool antigen test to 12:35-13:05 survey the updated prevalence of H. pylori infection for gastric cancer prevention
Jyh-Ming Liou (Taiwan)
Francis Mégraud (France)
Ming-Shiang Wu (Taiwan)
The History of HPSA Development
LEVOFLOXACIN SEQUENTIAL THERAPY VERSUS BISMUTH QUADRUPLE THERAPY IN THE SECOND-LINE AND THIRD-LINE TREATMENT OF HELICOBACTER PYLORI – A MULTICENTER RANDOMIZED TRIAL Jyh-Ming Liou1, Yu-Jen Fang2, Chieh-Chang Chen1, Po-Yueh Chen3, Ming-Jong Bair4, Ming-Shiang Wu1 National Taiwan University, Taipei, Taiwan1 National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan2 Chia-Yi Christian Hospital, Chiayi, Taiwan3 Mackay Memorial Hospital, Taitung Branch, Taiwan4 Background and Aims: We aimed to compare the eﬃcacy and safety of 14-day levofloxacin sequential therapy versus 10-day bismuth quadruple therapy in the second-line and third-line treatment of Helicobacter pylori (H. pylori) infection. Subjects and Methods: H. pylori infected patients who failed after one treatment were eligible in this open labeled, multicenter, randomized trial, and were randomized to receive (1) levofloxacin sequential therapy (EAML): esomeprazole 40 mg and amoxicillin 1 g for the first 7 days, followed by esomeprazole 40 mg, metronidazole 500 mg, and levoﬂoxacin 250 mg for another 7 days (all twice daily); or (2) bismuth quadruple therapy (BQ): esomeprazole 40mg twice daily, bismuth tripotassium dicitrate 300 mg four times a day, tetracycline 500mg four times a day, and metronidazole 500mg three times a day, for 10 days. The primary end point was the eradication rate in the second-line treatment according to intention to treat (ITT) analysis. The minimum inhibitory concentrations were determined by agar dilution test. Results: A total of 560 patients have been recruited and results were available for analysis in 533 patients up to Jan 2019. The demographic characteristics and antibiotic resistance rates were similar across the two treatment groups. The eradication rate in the second line treatment were 88.3% (235/266) and 88.4% (236/267) in the levofloxacin sequential therapy and bismuth quadruple therapy groups, respectively (p=1.000) in the ITT analysis. The eradication rates were 89.7% (235/262) and 92.9% (236/254) in the levoﬂoxacin sequential therapy and bismuth quadruple therapy according to PP analyses, respectively (p=0.195). The eﬃcacy of levoﬂoxacin sequential therapy, but not bismuth quadruple therapy, appeared to be aﬀected by levoﬂoxacin resistance. The frequency of any adverse eﬀects was higher in patients treated with bismuth quadruple therapy than levofloxacin sequential therapy (76.4% vs. 44.1%, p<0.001) Conclusions: Levofloxacin sequential therapy and bismuth quadruple therapy are similarly effective in the second-line treatment for H. pylori infection. (Trial registration number: NCT NCT03148366)
FIRST LINE HELICOBACTER PYLORI ERADICATION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS IN TAIWAN Chih-Chien Yao1,2, Chih-Ming Liang1,2, Chung-Mou Kuo1,2, Wei-Chen Tai2, Keng-Liang Wu2, Seng-Kee Chuah1,2 Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan1 College of Medicine, Chang Gung University, Taoyuan, Taiwan2 Purpose: To assess the eﬃcacy of ﬁrst line standard triple therapy for Helicobacter pylori in patients with type 2 diabetes (DM) and to investigate the clinical factors inﬂuencing treatment outcomes. Methods: In total, 719 patients with H. pylori infection were treated with 7-day standard first-line triple therapy, of whom 182 did and 537 did not have DM. Propensity score matched at a 1:2 ratios - for age, sex and body mass index was performed for the two groups, yielding a DM group with 147 patients and a nonDM group with 249 matched controls for analysis. Urea breath test was performed 6-8 weeks after treatment. Clinical and laboratory parameters were collected to identifying factors associated with failed eradication. Results: H. pylori was eradicated in 74.1% (95% conﬁdence interval [CI] = 66.2– 81.0) of the DM group and 85.3% (95% CI = 80.8–89.4) of the non-DM group (P = 0.005). Of 51 gastric biopsy samples cultured for H. pylori, 41 were positive. In the DM group, the rates of resistance to amoxicillin, clarithromycin, levofloxacin, and tetracycline were 0%, 50.0%, 50.0% and 0%, respectively. In the non-DM group, the comparable proportions were 2.9%, 17.1%, 22.9%, and 0 %, respectively. Univariate analysis revealed that DM (Odds ratio [OR], 1.771, 95% CI, 1.1672.668, p=0.006), clarithromycin resistance (OR, 15.273; 95% CI, 1.687-138.269; p=0.015), and amoxicillin resistance (OR, 4.672; 95% CI, 2.431-8.979; p<0.001) were independently associated with failure to eradicate H. pylori. Multivariate analysis showed that clarithromycin resistance was the major factor independently associated with failure of eradication (OR, 25.472; 95% CI, 1.549-418.956; p=0.023). Conclusions: First-line H. pylori eradication rates in patients with DM were signiﬁcantly lower than in those without DM, although neither group achieved >90% eradication.
THE EFFICACY OF LACTOBACILLUS ACIDOPHILUS AND RHAMNOSUS IN THE MODIFICATION OF GUT MICROBIOTA AND REDUCTION OF HELICOBACTER PYLORI BACTERIAL LOAD Mei-Jyh Chen, Ming-Shiang Wu, Chieh-Chang Chen, Jyh-Ming Liou National Taiwan University, Taipei, Taiwan Introduction: We aimed to assess the efficacy of Lactobacillus acidophilus and Lactobacillus rhamnosus in the reduction of bacterial load of H. pylori and in the modiﬁcation of gut microbiota. Methods: In this double-blind, randomized, placebo-controlled trial, we recruited adult subjects with moderate to high bacterial load of H. pylori deﬁned as a delta over baseline (DOB) value of 13C-Urea Breath Test (13C-UBT) of 10 or greater. Eligible subjects were randomized in a 1:1 ratio to receive (1) probiotic twice daily for 4 weeks or (2) placebo twice daily for 4 weeks. 13C-UBT was determined and fecal specimens were collected before treatment and weekly during treatment until 2 weeks after the end of treatment. Amplification of the V3 and V4 hypervariable regions of the 16S rRNA was done. Results: A total of 40 subjects were randomized to receive probiotic or placebo. DOB value was signiﬁcantly lower in the probiotic group than in placebo group at 4th week of treatment (DOB 26.0 vs 18.5, p =0.045). DOB value was signiﬁcantly reduced compared to baseline in the probiotic group (18.5 vs 26.7, p = 0.001), but not in the placebo group (26.0 vs. 25.0, p = 0.648). However, the DOB value increased again and there was no significant difference of DOB values between two groups at 1 and 2 weeks after cessation of probiotics. There were no signiﬁcant changes in the α-diversity and β-diversity at week 4 compared to baseline in the probiotic group and the placebo group. Conclusions: The use of Lactobacillus acidophilus and rhamnosus may reduce the bacterial load of H. pylori but the eﬀect was not observed one week after cessation of probiotic. There were no signiﬁcant changes in the composition of gut microbiota after treatment for 4 weeks.
C O M PA R I S O N O F T H E E F F I C A C Y O F T R I P L E T H E R A P Y WITH OR WITHOUT ACETYLCYSTEINE IN THE FIRST LINE OF HELICOBACTER PYLORI THERAPY: A MULTI-CENTER RANDOMIZED CONTROLLED TRIAL Chieh-Chang Chen1, Jiing-Chyuan Luo2, Yu-Jen Fang3, Jyh-Ming Liou1, Ming-Shiang Wu1 National Taiwan University, Taipei, Taiwan1 Taipei Veterans General Hospital, Taipei, Taiwan2 National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan3 Introduction: Recent studies show that H. pylori have the ability to form bioﬁlm and it is associated with antimicrobial resistance. N-Acetylcysteine (NAC), was found to reduce and prevent bacterial bioﬁlm formation. We aimed to assess whether NAC improve H. pylori eradication rate. Methods: H. pylori infected patients who failed after one treatment were eligible in this open labeled, multicenter, randomized trial, and were randomized to receive triple therapy containing N-acetylcysteine (NAC-triple): dexlansoprazole 60 mg qd, amoxicillin 1g bid, clarithromycin 500mg bid, NAC 600 mg bid, for 14 days; or standard triple therapy (Triple): dexlansoprazole 60 mg qd, amoxicillin 1g bid, clarithromycin 500 mg bid, NAC 600 mg bid, for 14 days. The primary end point was the eradication rate in the second-line treatment according to intention to treat (ITT) analysis. Results: We enrolled 463 H. pylori-infected subjects between 2014/1/1 ~ 2016/12/31. 239 participants were assigned to NAC-triple group and 221 patients received triple therapy. The demographic characteristics and antibiotic resistance rates were similar across the two treatment groups. The ITT analysis demonstrated H. pylori eradication in NAC-triple group and Triple therapy group were 81.2% and 86.9%, respectively (p = 0.10). The PP analysis showed H. pylori eradication in NAC-triple group and Triple therapy group were 86.2% and 89.3%, respectively (p = 0.32). The frequency of any adverse eﬀects was higher in patients treated with triple therapy than NAC-triple therapy (46.6% vs. 37.7%, p = 0.05). Conclusions: Dexlansoprazole-based standard triple therapy with or without N-acetylcysteine are similar eﬀective in the ﬁrst-line H. pylori treatment.
HELICOBACTER PYLORI IMAA POLYMORPHISMS CAN DETERMINE THE INCREASED HOST GASTRIC INTEGRIN Α5Β1 EXPRESSION AND GASTRIC CANCER RISK Hsiu-Chi Cheng1, Yu-Ching Tsai1, Chung-Tai Wu1, Er-Hsiang Yang1, Hsin-Yu Kuo1, Wei-Lun Chang1, Wei-Ying Chen1, Wei-Chun Cheng1, Hsiao-Bai Yang2, Bor-Shyang Sheu1 National Cheng Kung University, Tainan, Taiwan1 Ton‐Yen General Hospital, Hsinchu, Taiwan2 Introduction: Immunomodulating autotransporter (ImaA) protein (HP0289) is an outer membrane protein of Helicobacter pylori (H. pylori) and antagonizes the interaction between T4SS and integrin α5β1. The study validated whether ImaA amino acid polymorphisms can correlate to the expression of integrin α5β1 in host gastric tissues and to the risk of gastric cancer. Methods: A total of 139 H. pylori-infected patients were enrolled, including 27 isolated from subjected with gastric cancers and 112 from others. H. pylori strains were cultured and screened for imaA genotype by polymerase chain reaction and sequencing. The host’s integrin α5β1 expression was determined by immunohistochemistry. Results: The prevalence rate of imaA geno-positivity was 96.4%. Two different patterns of amino acid sequence from codon 42 to 180 were identiﬁed and named as the “two-type region.” The clinical H. pylori strains were divided into one of the two patterns as either the 26695 pattern (79.3%) or the J99 pattern. Ten amino acid polymorphisms were identiﬁed in the main regulatory region of ImaA, i.e., from codon 180 to 1008, including D324N, N331D, T351N, TN/--354-355AN, R/D511K, D/S536N, T538A, G657N, G776D/N, and P/S779A. All of these ten polymorphisms were correlated with gastric cancer, of which ImaA-N331D indicated the highest risk of gastric cancer (40% vs. 5.5%, OR 11.5 [95% CI 3.4-38.3], P<0.001). Subjects infected with H. pylori ImaA-538A isolates had increased integrin α5β1 expression on the gastric antrum than those infected with ImaA-538-non-A isolates (P =0.034). Conclusions: There are two patterns of amino acid sequence of H. pylori ImaA from codon 42 to 180. Ten amino acid polymorphisms of H. pylori ImaA can signiﬁcantly correlate to the risk of gastric cancer among infected hosts. H. pylori isolates as ImaA-N331D may carry the highest risk of gastric cancer and ImaA-538A isolates may increase the integrin α5β1 expression on the gastric antrum.
COMBINED CORPUS PREDOMINANT GASTRITIS INDEX (CGI) AND INTESTINAL METAPLASIA EXPAND COVERAGE OF GASTRIC CANCER RISK DETERMINATION Yu-Ching Tsai1, Hsiao-Bai Yang2, Hsin-Yu Kuo3, Hsiu-Chi Cheng3, Wei-Lun Chang3, Ming-Tsung Hsieh3, Chen-Chan Lu4, Bor-Shyang Sheu3 Department of Internal Medicine, Ministry of Health and Welfare Tainan Hospital, Tainan, Taiwan1 Department of Pathology, Ton‐Yen General Hospital, Hsinchu, Taiwan2 Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan3 Department of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan4 Introduction: The corpus-predominant gastritis index (CGI) is a potentially earlier marker than spasmolytic polypeptide-expressing metaplasia (SPEM) and intestinal metaplasia (IM) to identify gastric cancer (GCA) risk in H. pylori-infected patients. The validation of CGI in the GCA patients with diﬀerent SPEM/IM features shall be crucial to establish the future screening strategy. Methods: We enrolled 109 GCA patients to provide either surgical or biopsy specimens on both tumor and non-tumor parts to review CGI and SPEM/IM features. Results: Based on the SPEM/IM features on the non-tumor part, 20(18%) gastric cancer patients had no SPEM or IM, 5(5%) had SPEM only, 45(41%) had SPEM&IM, and 39(36%) had IM only. The prevalence rates of CGI were high in most GCA patients with non-SPEM/IM (100%), SPEM only (100%) and both SPEM&IM (88%), except those with IM only (63%) (p=0.049). The SPEM/IM features of gastric cancer patients were concordantly correlated between tumor and non-tumor parts (p<0.001). Patients with SPEM only or without SPEM/IM were younger, female predominant, and higher rates of tumor location at corpus than those with IM (p<0.01). The corpus tumors without SPEM/IM or SPEM only were more diﬀuse type (p=0.046) and poor diﬀerentiation (p=0.002) than others. Almost all gastric cancer patients presented with either CGI or IM in non-tumor parts. Conclusions: GCA can really exist with diverse precancerous progressions. To apply both CGI and IM are mandatory to achieve near-full coverage of gastric cancer risk determination.
THE IDENTIFICATION OF GENETIC SUSCEPTIBILITY TO GASTRIC INTESTINAL METAPLASIA IN HIGH RISK GASTRIC CANCER FAMILY MEMBER BY GWAS STUDY Hsin Yu Kuo1,2, Ta-Chien Tseng1, Hsiu-Chi Cheng1,2, Wei-Lun Chang1,2, Hsiao‐Bai Yang3, Cheng-Chang Lu2,4, Bor‐Shyang Sheu1,2 National Cheng Kung University Hospital, Tainan, Taiwan1 National Cheng Kung University, Tainan, Taiwan2 Department of Pathology, Ton‐Yen General Hospital, Hsinchu, Taiwan3 Department of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan4 Background and aims: Intestinal metaplasia (IM) is a well-recognized metaplasia precursor of gastric adenocarcinoma (GC), which is considered “point of no return”. The familial relatives of gastric cancer (GCF) suﬀerers have genomic susceptibility that predisposes them to the gastric IM after H. pylori infection. The diagnosis and surveillance of this metaplasia phenotype need aggressive and frequent endoscopic biopsy for histologic evaluation, while, no efficiency and practical non-invasive diagnostic tools are available in clinical scenarios. The aim of this study is to identify the susceptibility loci of IM by comparing the SNP proﬁles between individuals with high risk for gastric IM and low risk subjects. These results can provide screening and surveillances biomarkers to predict more precisely the risk for gastric cancer development in high-risk populations. Methods: We prospectively enrolled 30 1st-degree GCF, and subgroup them into with and without IM according to endoscopic histology. The genomic-wide association study (GWAS) was performed by using a high-density SNP array, Asia Precision Medicine Array (Asia PMRA) to identify the susceptibility genes. Results: Around 89 SNPs identified to distinguish the group with/without IM and showed at least 70 % sensitivity and specificity. Gene-set enrichment analysis highlighted key roles in IM regulation for the pathways related to Integrin priming and regulation of epithelial-to-mesenchymal transition signaling with the three structural genes, HMGA2, SMAD2 and collagen II. Besides, 3 SNPs located in the NQO2 gene showed strong correlation with IM, while NQO2 gene was reported to associate with breast carcinomas. Conclusions: Genetic variants identiﬁed were implicated in the etiology of gastric metaplasia phenotypes. Much work remains to functionally characterize genetic loci and for clinical utility, but accruing insights into the biological basis promise to point to novel therapeutic and diagnostic strategies.
HELICOBACTER PYLORI – A GENERAL SURGEON’S EXPERIENCE Anson Li CHI St. Alexius Medical Center, Williston, ND, USA With the discovery of H. pylori, the adage ‘no acid, no ulcer’ has now been evolved to ‘no H. pylori, no ulcer’. H. pylori is implicated in numerous gastroduodenal diseases. The understanding of its prevalence helps to identify infection source as well as transmission, treatment and eradication. The present study details my experience of the prevalence, diagnosis, and treatment of H. pylori in my general surgery practice in rural North Carolina and North Dakota. Sensitivity of detection aﬀected by biopsy method; and the alarming high incidence in certain population. A case of MALToma, from treatment to outcome, will also be presented.
Acknowledgement The Organizing Committee would like to extend our great gratitude to the following sponsors who generously contribute and support to the success of the 10th Asian-PaciďŹ c Topic Conference (APTC).
Harvester Trading Co., Ltd.
Eisai Taiwan, Inc.
Takeda Pharmaceutical Taiwan Limited
Panion & BF Biotech Inc.
Swiss Pharma Co., Ltd.
Strong Biotech Corporation
Firstep Bioresearch, Inc.
Yuan Yu Industry Co., Ltd.
Bureau of Foreign Trade, Ministry of Economic AďŹ€airs
Economic Development Bureau, Kaohsiung City Government
Ministry of Science and Technology
VIP / Preview Room
新 光 公 園 Xingguang Riverside Park
Conference Room E
Poster boards Area
Chenggong 2nd Rd
東側空橋 East Bridge
West Entrance 西側空橋 West Bridge
Poster Boards Area
南 館 挑 空 South Hall
VIP Room / Preview Room
會場飯店位置圖 Venue / Hotel Location Map
Kaohsiung Exhibition Center The Grand Hi-Lai Hotel
To Train Station
民生一路 Min-Sheng 1st Rd. 中央公園 Central Park
五福二路 Wu-Fu 2nd Rd.
Chen-Kung 2nd Rd.
新光路 Hsin-Kuang Rd.
Chung-Shan 2nd Rd.
三多四路 San-Do 4th Rd.
四維三路 Su-wei 3rd Rd.
Fuxing 2nd Rd.
Chung-Hua 4th Rd.
Tzu-Chang 3rd Rd.
四維四路 Su-wei 4st Rd.
民生二路 Min-Sheng 2nd Rd.
新田路 Xintian Rd.
七賢一路 Qixian 1st Rd.
七賢二路 Qixian 2nd Rd. 中正四路 Chung-Cheng 4th Rd.
Howard Plaza Hotel
To Taiwan High Speed Rail Station
五福三路 Wu-Fu 3rd Rd.
Han-Hsien International Hotel
三多三路 San-Do 3rd Rd. 一心二
林森四路 Linsen 4th Rd. 往機場 To Air Port
會場交通資訊 Transportation Information
捷運市議會站 O4 City Council
● 飛機 - 高雄小港國際機場 小港國際機場 → 轉乘捷運至三多商圈站 → 步行約 10 分鐘即可抵達。 ● 高鐵 (台北至高雄僅需 1.5 小時) 1.自左營高鐵站開車約 30 分鐘即可抵達。 2.自左營高鐵站轉乘捷運至三多商圈站（15分鐘） → 步行約 10 分鐘即可抵達。 ● 捷運 三多商圈站 → 步行約 10 分鐘即可抵達。 ● 環狀輕軌 營運時段：07:00(首班車)～22:00(末班車) 1.全日班距15分鐘。營運期間列車進站後，旅客上 下車須自行按壓開門鈕。 2.搭乘至C8 高雄展覽館→ 步行約5 分鐘即可抵達。
捷運三多商圈站 Sanduo Shopping District
● 市區公車 1.本館外公車站牌，站名：高雄展覽館 紅21、紅22、168環狀東幹線 2.臺灣銀行附近，站名：輕軌高雄展覽館站 (新光碼頭) 214A、168環狀東幹線 ● 公共腳踏車 高雄展覽館附近50公尺，新光路+成功路 City Bike 租 賃站。 ● 自行開車 – 中山高速公路 北上：中山高國道一號 → 三多路出口下交流道 → 沿 三多路直行至成功二路左轉 → 抵達。 南下：中山高國道一號 → 高雄端/中山路出口下交流 道 → 右轉中山四路直行至新光路左轉 → 成功 二路左轉 → 抵達。