Community-based Helicobacter pylori screening and empiric eradication in health promotion program participants aged 50–69 Years in Chiayi county, Taiwan

BACKGROUND: Taiwan has launched community-based Helicobacter pylori (H. pylori) screening programs in select areas. However, in many parts of Taiwan, the most effective treatment strategies remain unclear. METHODS: In July 2023, H. pylori stool antigen (HpSA) screening for adults aged 50-69 years was added to the county-wide community-based health promotion program conducted by the Chiayi County Health Bureau. This single-center retrospective analysis included 531 HpSA-positive individuals who were evaluated at Chiayi Chang Gung Memorial Hospital between July 2023 and June 2024. RESULTS: Among the 5749 screened adults aged 50-69 years in Chiayi County, HpSA positivity was 25.6% (95% CI, 24.5-26.7). Of 1470 HpSA-positive individuals identified through screening, 531 (36.1%) were evaluated at the study hospital. Of them, 458 (86.3%) underwent endoscopy, which identified gastric ulcers in 24.5%, duodenal ulcers in 17.0%, and both in 6.6%. Rapid urease test and histological assessment were performed in 316 and 158 patients, respectively, yielding a positivity rate of 87.0% and 86.7% respectively. Among the 441 patients with available follow-up data, eradication rates were 94.7% (216/228) for those receiving 14-day clarithromycin-based triple therapy and 93.1% (149/160) for those receiving pooled 7-14-day concomitant therapy (p = 0.508). Reverse hybrid therapy achieved a 100% eradication rate in 20 patients, without significant difference compared to triple therapy (p = 0.293). CONCLUSION: Among screened adults aged 50-69 years in Chiayi County, HpSA positivity was approximately 25.6%. Fourteen-day triple therapy, 7-14-day concomitant therapy and reverse hybrid therapy all achieved high eradication rates.