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H. pylori eradication reduced gastric cancer incidence
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Helicobacter pylori eradication therapy reduced the incidence of gastric cancer in asymptomatic Asian patients, according to recent study data.
“Gastric cancer is the third commonest cause of death from cancer, and H. pylori is causally implicated in its etiology,” study researcher Alexander C. Ford, MBChB, MD, FRCP, associate professor, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, United Kingdom, told Healio.com/Gastroenterology. “The World Health Organization classed H. pylori as a human carcinogen 20 years ago, but, as yet, no country at high risk for gastric cancer (eg, China, Japan, Korea) has adopted testing for and treatment of H. pylori in the general population as a means of preventing this disease.”
Alexander C. Ford
To ascertain whether eradication therapy has a preventive effect on gastric cancer, Ford and colleagues performed a systematic review and meta-analysis of randomized controlled trials derived from several databases searched through 2013. The six eligible trials, the majority of which were conducted in Japan or China with a minimum follow-up of 2 years, collectively tested the effect of eradication therapy lasting at least 1 week on subsequent gastric cancer incidence in 3,294 healthy asymptomatic-infected adults compared with 3,203 controls.
Gastric cancer occurred in 1.6% of the eradication therapy group compared with 2.4% of controls (RR=0.66; 95% CI, 0.46-0.95). With an assumed control risk of 2.4%, the number needed to treat was 124 (95% CI, 78-843), but when assuming lifelong persistence of eradication therapy benefit, the number needed to treat ranged as low as 15 for infected men in regions with high gastric cancer risk, such as China or Japan, and up to 245 for infected women in low-risk regions such as the United States.
“Our meta-analysis of randomized controlled trials using eradication therapy suggests that this approach significantly reduces the subsequent occurrence of gastric cancer,” Ford said. “However, almost all trials were conducted in Asian populations, so these results may not be applicable in the Western world.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Stephen Meltzer, MD
The authors of this paper addressed an important controversy: Does searching for Helicobacter pylori and treating with eradication therapy reduce gastric cancer (GC) incidence in healthy asymptomatic infected individuals?
They performed a meta-analysis of clinical trials between 2001 and 2013, identifying 1,560 citations, of which six individual randomized controlled trials were eligible. Fifty-one (1.6%) GCs occurred in 3,294 individuals receiving eradication therapy vs. 76 (2.4%) in 3,203 control subjects (RR=0.66; 95% CI, 0.46-0.95). If the benefit of eradication therapy was assumed to persist lifelong, the number needed to treat was 15 for Chinese men and 245 for US women. Thus, these data provide limited, moderate-quality evidence that searching for and eradicating H. pylori reduces GC in healthy asymptomatic infected Asians, although the data may not necessarily apply to other populations.
There has been controversy in this area in some quarters, partially due to the suspected protective effect of H. pylori against esophageal adenocarcinoma. Nevertheless, and notwithstanding its limitations, this study shifts the pendulum toward eradication of H. pylori, a class I carcinogen that accounts for the vast majority of GC, the third-highest cause of cancer death in the world today.
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