Gastric Cancer Rates Higher Among Patients Treated for H. pylori

Issue: August 2019

SAN DIEGO — Patients who receive antibiotic treatment for Helicobacter pylori infection experience gastric cancer at rates higher than the general population, and several risk factors can increase that risk even further, according to data presented at Digestive Disease Week.

Elizabeth Dong, MD, of the department of gastroenterology at Kaiser Permanente Los Angeles, said H. Pylori is a known risk factor for gastric cancer, but there are no clear guidelines on how it should impact surveillance.

“It’s unclear whether or not surveillance for gastric cancer is beneficial in this population post H. pylori treatment,” she said.

Researchers conducted a retrospective cohort study of patients diagnosed with H. pylori infection between 2006 and 2017 within the Kaiser Permanente Southern California health care system. They explored risk factors for gastric cancer after H. pylori treatment.

Of 166,078 total patients with H. pylori infection (mean age 50.6 years. 61% women, 58.8% Hispanic) and 124,528 patients who received treatment within 90 days of diagnosis date, researchers identified 391 cases of gastric cancer (0.3%). The overall rate of gastric cancer among the cohort treated for H. pylori was 70 cases per 100,000 person years. Dong said the background rate of gastric cancer at Kaiser Permanente Southern California is 8.2 cases per 100,000 person years.

In their analysis, researchers determined that being older than 65 years (HR = 2.86; 95% CI, 2.3–3.54), male sex, (HR = 1.66; 95% CI, 1.35–2.04) peptic ulcer disease (HR = 1.69; 95% CI, 1.24–2.3), and family history of gastric cancer (HR = 2.64; 1.85–3.75) were all independent risk factors for the development of prevalent gastric cancer after H. pylori treatment. Patients with peptic ulcer disease within 2 years of H. pylori treatment were at the greatest risk.

“Cases of H. pylori treatment with peptic ulcer disease may represent prevalent gastric cancer,” Dong said. “There remains a residual risk of incident gastric cancer among those treated for H. pylori. In our cohort, we saw a median time to diagnosis of 2.1 years, suggesting that endoscopy may be warranted for surveillance of gastric cancer in these high-risk patients.” – by Alex Young

Reference:

Dong E, et al. Abstract 439. Presented at: Digestive Disease Week; May 18-21, 2019; San Diego.

Disclosures: Dong reports no relevant financial disclosures. Please see the meeting disclosure index for all other authors’ relevant financial disclosures.