BACKGROUND & AIMS: Screening for, and treating, Helicobacter pylori in the general population or patients with early gastric neoplasia could reduce incidence of, and mortality from, gastric cancer. We updated a meta-analysis of randomized controlled trials (RCTs) examining this issue.
METHODS: We searched the literature through October 4, 2024, identifying studies examining effect of eradication therapy on incidence of gastric cancer in H pylori-positive adults without gastric neoplasia at baseline or H pylori-positive patients with gastric neoplasia undergoing endoscopic mucosal resection (EMR) in either RCTs or observational studies. The control arm received placebo or no eradication therapy in RCTs and no eradication therapy in observational studies. Follow-up was =2 years. We estimated relative risks (RR) of gastric cancer incidence and mortality.
RESULTS: Eleven RCTs and 13 observational studies were eligible. For RCTs, RR of gastric cancer was lower with eradication therapy in healthy H pylori-positive individuals (8 RCTs, 0.64; 95% confidence interval [CI], 0.48-0.84) and H pylori-positive patients with gastric neoplasia undergoing EMR (3 RCTs, 0.52; 95% CI, 0.38-0.71). RR of death from gastric cancer was lower with eradication therapy in healthy H pylori-positive individuals (5 RCTs, 0.78; 95% CI, 0.62-0.98). In observational studies, RR of future gastric cancer was lower with eradication therapy in H pylori-positive subjects without gastric neoplasia at baseline (11 studies, 0.56; 95% CI, 0.43-0.73) and H pylori-positive patients with gastric neoplasia undergoing EMR (2 studies, 0.19; 95% CI, 0.06-0.61).
CONCLUSIONS: This meta-analysis provides further evidence that administering eradication therapy prevents gastric cancer in H pylori-positive individuals, with consistency in results among studies of different design.
| Specialty | Score |
|---|---|
| Internal Medicine | |
| Gastroenterology | |
| Family Medicine (FM)/General Practice (GP) | |
| General Internal Medicine-Primary Care(US) | |
| Infectious Disease | Coming Soon... |
| Oncology - Gastrointestinal | Coming Soon... |
Testing for H pylori is most commonly done to evaluate patients with upper GI symptoms. When positive, treatment is provided to improve those symptoms. This study suggests there is a potential further benefit in terms of the risk for future gastric cancer. The number needed to treat is not provided nor does it address whether screening asymptomatic patients for H pylori could reduce future gastric cancer.
I think this article may serve to remind us that there is a successful treatment for HP. We should keep this in mind, particularly since the benefit (of treatment) is clearly positive.
This is not an area I keep up with, but if there is in fact a causal relationship between H pylori eradication treatment and a decrease risk for death from gastric cancer, then this is something primary care should know.
This is an update adding new data to a meta-analysis and confirming the effect of eradication of H pylori on subsequent gastric cancer.
This is a really important topic that has some uncertainties in the applicability to North America and Europe.
Eradicating H pylori reduces the risk for gastric cancer, at least in East Asia. Unclear whether the findings can be extrapolated to North America/Europe.
This meta-analysis is highly informative. While H pylori is commonly encountered in inpatient and outpatient settings, the consistent evidence presented here across both RCTs and observational studies clarifies the magnitude of cancer risk reduction achievable with eradication therapy. This is especially relevant for patients with known ulcers or a family history of gastric cancer. The reported NNT values and mortality reduction strengthen the argument for population-based screening in high-risk regions. The article raises awareness of data most internists may not know.
, McMaster University