幽門螺旋桿菌篩檢與根除：臺灣實證經驗與全球胃癌預防展望

Helicobacter pylori Screening and Eradication: Evidence from Taiwan and Global Perspectives on Gastric Cancer Prevention

幽門螺旋桿菌（Helicobacter pylori）感染為胃癌主要致病因子，提早篩檢及根除，可以有效降低胃癌風險。在臺灣歷經20多年本土科學實證中，以幽門桿菌篩檢為基礎進行的胃癌防治計畫最早是從離島與偏鄉試辦，逐步推展為全國性預防保健政策。本論文回顧2004年發展至今之歷程，首先於全國胃癌發生率最高的馬祖推動全面篩檢，長期追蹤結果發現可降低胃癌與消化性潰瘍發生率。2012年彰化縣地區試辦幽門桿菌與糞便潛血的二合一篩檢，並於2014年在衛生福利部科技研究計畫：「胃癌兩階段篩檢計畫服務模式」的補助支持下進行隨機對照研究，證明雙管齊下的方法，不僅讓民眾更願意參與，也有效降低了胃癌發生率。2018年國民健康署在原住民族鄉推行幽門桿菌篩檢政策，並推動以家戶為單位進行篩檢，避免家人之間互相傳染，並於2024年推動幽門螺旋桿菌糞便抗原篩檢試辦計畫，同時建立胃癌篩檢電子化資訊系統，歷經2年試辦後，於2026年正式啟動全國性的胃癌預防保健政策，成為國家第6項癌症篩檢政策。這不僅是台灣將胃癌預防勝於治療、從地方推向全國的重要里程碑，也為全球推動幽門桿菌篩檢與根除，提供重要公共衛生政策參考。

Infection with Helicobacter pylori is the major etiological factor for gastric cancer, and eradication therapy can effectively reduce gastric cancer risk. Over the past two decades, Taiwan has progressively transformed H. pylori prevention from regional pilot programs into a nationwide preventive healthcare policy based on substantial local scientific evidence. This article reviews the development of this strategy from 2004 to the present. The first population-based screening and eradication program was implemented in the Matsu Islands, the region with the highest gastric cancer incidence in Taiwan, where long-term follow-up demonstrated significant reductions in gastric cancer and peptic ulcer disease. In 2012, Changhua County initiated a combined screening program integrating H. pylori stool antigen testing with fecal immunochemical testing (FIT) for colorectal cancer. Supported by the Ministry of Health and Welfare in 2014, the project expanded into a pragmatic randomized community-based trial, showing that combined screening increased participation and provided additional reduction in gastric cancer incidence beyond the established mortality benefit of FIT screening alone. Because gastric cancer incidence is substantially higher among indigenous populations, H. pylori screening was incorporated into the Indigenous Health Inequality Improvement Action Plan in 2018, with the introduction of family-based screening to reduce intrafamilial transmission. Integrating stool antigen testing, digital quality-monitoring systems, and organized screening principles, Taiwan completed a pilot implementation phase before nationwide rollout. In 2024, the National Health Insurance expanded reimbursement for eradication therapy, and in 2026, the Health Promotion Administration officially launched nationwide H. pylori screen-and-treat gastric cancer prevention as Taiwan’s sixth national cancer screening policy. This experience provides an important public health model for other regions prevalent for gastric cancer worldwide.