H. pylori eradication may reduce gastric cancer incidence
Eradication of Helicobacter pylori may prevent the development of gastric cancer in healthy, asymptomatic Asian individuals, according to a recently published review.
“The findings of this systematic review and meta-analysis add to the increasing evidence that eradicating H. pylori in the general population has the potential to prevent gastric cancer,” Paul Moayyedi, MD, from McMaster University in Canada, said in a press release. “International guidelines for the management of H. pylori infection may change as a result. More research is needed on the extent of this effect and on any potential harms of H. pylori treatment before it can be advocated as a means of preventing gastric cancer.”
Aiming to determine the effectiveness of H. pylori eradication in reducing gastric cancer incidence among the general population, Moayyedi and colleagues analyzed randomized controlled trials published through 2013 that compared 1 or more weeks of H. pylori therapy with placebo or no treatment in preventing gastric cancer in asymptomatic infected adults.
A total of six trials (n = 6,497) were included in the analysis, five of which involved Asian populations. Of 3,294 individuals who underwent H. pylori eradication, 1.6% developed subsequent gastric cancer compared with 2.4% of the 3,203 individuals who received placebo or no treatment.
H. pylori eradication was superior compared with placebo or no treatment in preventing subsequent development of gastric cancer overall (RR = 0.66; 95% CI, 0.46-0.95). According to results from one trial, 0.2% of 817 individuals who underwent H. pylori eradication therapy developed subsequent esophageal cancer compared with 0.1% of 813 placebo controls (RR = 1.99; 95% CI, 0.18-21.91). According to results from three trials (n = 4,475), there was no evidence of any preventive benefit of H. pylori eradication on gastric cancer mortality compared with placebo or no treatment (RR = 0.67; 95% CI, 0.4-1.11). There was no evidence of a preventive effect of H. pylori eradication on all-cause mortality, and data on adverse events were poorly reported.
“These data provide limited, moderate-quality evidence that searching for and eradicating H. pylori can reduce the future incidence of gastric cancer in healthy asymptomatic people who are infected with the bacterium,” the authors concluded. “However, as the only trial conducted in a non-Asian population failed to demonstrate any benefit of such an approach, these findings may not necessarily apply to the rest of the world.”
“The review highlights the need for further trials in different populations to provide more evidence, and these should report both the benefits and harms of such an approach,” Alex Ford, MBChB, MD, FRCP, from St. James's University Hospital, and Leeds University in the UK, said in the release. – by Adam Leitenberger
Disclosure: Moayyedi reports he is the joint coordinating editor of the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group, however editorial decisions about this review were made by the other joint coordinating editor and independent peer reviewers. The other researchers report no relevant financial disclosures.