TOGAS

This study is part of a European initiative to determine the best way to screen for and prevent stomach cancer at a population level. Currently stomach cancer is the 5^th leading cause of cancer related deaths within Europe and most cases are advanced at diagnosis. 

Helicobacter Pylori

The major cause of stomach cancer is a bacteria called Helicobacter pylori (H. pylori). This bacteria is found in the stomach and is thought to infect up to 50% of the world’s population. It is acquired in childhood by person-to-person transmission and will persist throughout life unless treated. It is currently only tested for in people who have symptoms and, as a result, the true frequency at which it occurs in people without symptoms in Ireland is largely unknown.

H. pylori can be tested for using a number of methods, i.e., a blood sample, a stool sample, a breath test, or an endoscope with samples taken directly from the stomach. Once found, it can be treated with medications to kill the bacteria (i.e., antibiotics). For the majority of people treatment is effective at getting rid of the bacteria.

In Ireland, we are currently participating in both Pilot 1 and Pilot 2 of the ongoing TOGAS consortium studies.

Pilot 1

Pilot 1 focuses on adults aged 30–34 years, with a target of recruiting 1,000 participants for H. pylori serology testing. Individuals who test positive are offered a Urea Breath Test (UBT) to determine active infection. Those with confirmed infection receive free quadruple therapy, followed by a repeat UBT eight weeks post-treatment to confirm eradication.
To date, we have recruited almost 600 participants through GP practices, the Defence Forces, and the Construction Workers Health Trust. Our findings show a H. pylori prevalence of just over 10%, and we have successfully treated 97% of those with a positive UBT.

Pilot 2

Pilot 2 focuses on individuals aged 50–74 years who are already scheduled for either a FIT-positive (The presence of blood in bowel motion) or surveillance colonoscopy (Bowel Screening Programme) and offers an additional gastroscopy during the same session. This study addresses a key evidence gap by examining the prevalence of Helicobacter pylori, precancerous lesions, and gastric cancer in this older age group in Ireland.
So far, we have recruited 90 participants and have observed a H. pylori positivity rate of just over 20%. Our goal is to recruit 110 participants by the end of the study, and we remain on track to achieve this.

Ireland’s future approach

Together, these pilot studies are generating the crucial evidence that will inform Ireland’s future approach to gastric cancer prevention and early detection.