H. pylori treatment reduces gastric cancer risk for certain individuals with family history of disease
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Treatment to eradicate Helicobacter pylori infection decreased the risk for gastric cancer among first-degree relatives of individuals with the malignancy, according to results of a randomized study published in The New England Journal of Medicine.
“About half of world population is infected with this organism,” Il Ju Choi, MD, PhD, professor in the department of cancer control and population health at National Cancer Center in South Korea, told Healio. “The majority of infected persons got infected in childhood and usually have no symptoms or signs. However, about 10% to 15% of those infected develop peptic ulcer (duodenal or gastric ulcer), epigastric soreness or hunger pain. Gastric or duodenal ulcer bleeding or obstructive symptoms may develop in those who experience gastric ulcers.
“If a person is infected in adulthood they usually develop acute gastritis, which includes epigastric pain, nausea, soreness and/or anorexia,” he added.
H. pylori infection also is a primary risk factor for gastric cancer, along with family history of gastric cancer.
“A chronic H. pylori infection lasting decades causes atrophic change in the gastric mucosa, including loss of glandular structure of gastric mucosa, or intestinal metaplasia,” Choi said. “This mucosal change predisposes a person to gastric cancer and is considered a consistent risk factor for gastric cancer development.”
Although studies have confirmed the association between H. pylori and gastric cancer, data on whether treatment for the infection decreases gastric cancer risk are lacking.
For this reason, Choi and colleagues randomly assigned 1,838 patients with H. pylori and a family history of gastric cancer in first-degree relatives to H. pylori eradication therapy (n = 917), which consisted of 30 mg lansoprazole, 1,000 mg amoxicillin and 500 mg clarithromycin taken twice daily for 7 days, or placebo (n = 921).
The groups had similar baseline characteristics, including mean age (48.8 years), and percentage of men (49.9% treatment group vs. 49.1% placebo group).
Development of gastric cancer served as the study’s primary outcome. Development of gastric cancer according to H. pylori eradication status, assessed during the follow-up period, served as a secondary outcome.
After median follow-up of 9.2 years, 10 individuals in the treatment group and 23 individuals in the placebo group developed gastric cancer (HR = 0.45; 95% CI, 0.21-0.94).
Among the 10 participants in the treatment group who developed gastric cancer, five had persistent H. pylori.
Gastric cancer developed in five of 608 participants (0.8%) who achieved H. pylori eradication and in 28 of 979 participants (2.9%) who had persistent infection (HR = 0.27; 95% CI, 0.1-0.7). Thirty developed stage I disease and three developed stage II disease.
Sixteen patients in the treatment group and 18 patients in the placebo group died. Researchers observed no significant difference is OS rates between groups.
Adverse events, mostly mild, occurred among 53% of participants in the treatment group and 19.1% of the placebo group. Common adverse events in the treatment group included taste alteration, nausea, diarrhea and abdominal pain.
“We believe that people who have a family history of gastric cancer should be actively tested for H. pylori and treated if found,” Choi said. “Current United States consensus reports have conflicting view on this issue, but our study clearly suggests that the infection should be treated.” – by John DeRosier
For more information:
Il Ju Choi, MD, PhD, can be reached at cij1224@ncc.re.kr.
Disclosures: Choi reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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