Early Eradication of H. pylori May Prevent Gastric Cancer

Among patients with peptic ulcer disease, early eradication of Helicobacter pylori protects against the development of gastric cancer, Dr. Chun-Ying Wu and colleagues.

In a retrospective cohort study of more than 80,000 patients throughout China who were hospitalized for peptic ulcer disease, those who received therapy to eradicate H. pylori soon after recovery showed a risk of gastric cancer similar to that in the general population. In contrast, patients who did not receive such therapy until years later had a higher risk of developing gastric cancer.

In animal models, a causal link between H. pylori infection and gastric cancer has been proved, with studies showing that H. pylori induces the cancer by first causing atrophic gastritis, intestinal metaplasia, and dysplasia.

However, the findings in human studies have been conflicting.

Dr. Wu of China Medical University in Taichung, Taiwan, and colleagues conducted a retrospective study comparing 54,576 patients who received timely treatment with 25,679 who, for unknown reasons, did not receive treatment to eradicate H. pylori until 1 or more years after an index hospitalization for peptic ulcer disease.

All the study subjects were initially hospitalized between 1997 and 2005 with a primary diagnosis of peptic ulcer, including gastric, duodenal, and nonspecific ulcer. Treatment to eradicate H. pylori included a proton pump inhibitor or H₂ receptor blocker, plus clarithromycin or metronidazole, plus amoxicillin or tetracycline, with or without the addition of bismuth. All the subjects were followed for 2-10 years, with an average of 7.5 years of follow-up.

In the “early-eradication group,” the median interval between hospitalization for peptic ulcer disease and receipt of eradication therapy was 14 days. In contrast, in the “late-eradication group,” the median interval was 1,053 days.

The cumulative incidence of gastric cancer in the early-intervention group was similar to that in the general Chinese population, but such incidence was significantly higher in the late-eradication group. Moreover, gastric cancer risk was higher still in late-eradication patients who were at high risk because of older age, male sex, or ulcer complications. “The result [indicates that there is a] stronger protective role of H. pylori eradication in high-risk populations,” they said.

H. pylori eradication conveyed protection in all age groups, not just in young patients. “The highest protective effect was actually found in the 60-69 age group, with the second-highest protective effect in the 50-59 age group,” the researchers said.

The researchers were unable to determine whether treatment to eradicate H. pylori was successful or not.

This study was supported in part by China's National Health Research Institutes. No financial conflicts of interest were reported.

Among patients with peptic ulcer disease, early eradication of Helicobacter pylori protects against the development of gastric cancer, Dr. Chun-Ying Wu and colleagues.

In a retrospective cohort study of more than 80,000 patients throughout China who were hospitalized for peptic ulcer disease, those who received therapy to eradicate H. pylori soon after recovery showed a risk of gastric cancer similar to that in the general population. In contrast, patients who did not receive such therapy until years later had a higher risk of developing gastric cancer.

In animal models, a causal link between H. pylori infection and gastric cancer has been proved, with studies showing that H. pylori induces the cancer by first causing atrophic gastritis, intestinal metaplasia, and dysplasia.

However, the findings in human studies have been conflicting.

Dr. Wu of China Medical University in Taichung, Taiwan, and colleagues conducted a retrospective study comparing 54,576 patients who received timely treatment with 25,679 who, for unknown reasons, did not receive treatment to eradicate H. pylori until 1 or more years after an index hospitalization for peptic ulcer disease.

All the study subjects were initially hospitalized between 1997 and 2005 with a primary diagnosis of peptic ulcer, including gastric, duodenal, and nonspecific ulcer. Treatment to eradicate H. pylori included a proton pump inhibitor or H₂ receptor blocker, plus clarithromycin or metronidazole, plus amoxicillin or tetracycline, with or without the addition of bismuth. All the subjects were followed for 2-10 years, with an average of 7.5 years of follow-up.

In the “early-eradication group,” the median interval between hospitalization for peptic ulcer disease and receipt of eradication therapy was 14 days. In contrast, in the “late-eradication group,” the median interval was 1,053 days.

The cumulative incidence of gastric cancer in the early-intervention group was similar to that in the general Chinese population, but such incidence was significantly higher in the late-eradication group. Moreover, gastric cancer risk was higher still in late-eradication patients who were at high risk because of older age, male sex, or ulcer complications. “The result [indicates that there is a] stronger protective role of H. pylori eradication in high-risk populations,” they said.

H. pylori eradication conveyed protection in all age groups, not just in young patients. “The highest protective effect was actually found in the 60-69 age group, with the second-highest protective effect in the 50-59 age group,” the researchers said.

The researchers were unable to determine whether treatment to eradicate H. pylori was successful or not.

This study was supported in part by China's National Health Research Institutes. No financial conflicts of interest were reported.

Among patients with peptic ulcer disease, early eradication of Helicobacter pylori protects against the development of gastric cancer, Dr. Chun-Ying Wu and colleagues.

In a retrospective cohort study of more than 80,000 patients throughout China who were hospitalized for peptic ulcer disease, those who received therapy to eradicate H. pylori soon after recovery showed a risk of gastric cancer similar to that in the general population. In contrast, patients who did not receive such therapy until years later had a higher risk of developing gastric cancer.

In animal models, a causal link between H. pylori infection and gastric cancer has been proved, with studies showing that H. pylori induces the cancer by first causing atrophic gastritis, intestinal metaplasia, and dysplasia.

However, the findings in human studies have been conflicting.

Dr. Wu of China Medical University in Taichung, Taiwan, and colleagues conducted a retrospective study comparing 54,576 patients who received timely treatment with 25,679 who, for unknown reasons, did not receive treatment to eradicate H. pylori until 1 or more years after an index hospitalization for peptic ulcer disease.

All the study subjects were initially hospitalized between 1997 and 2005 with a primary diagnosis of peptic ulcer, including gastric, duodenal, and nonspecific ulcer. Treatment to eradicate H. pylori included a proton pump inhibitor or H₂ receptor blocker, plus clarithromycin or metronidazole, plus amoxicillin or tetracycline, with or without the addition of bismuth. All the subjects were followed for 2-10 years, with an average of 7.5 years of follow-up.

In the “early-eradication group,” the median interval between hospitalization for peptic ulcer disease and receipt of eradication therapy was 14 days. In contrast, in the “late-eradication group,” the median interval was 1,053 days.

The cumulative incidence of gastric cancer in the early-intervention group was similar to that in the general Chinese population, but such incidence was significantly higher in the late-eradication group. Moreover, gastric cancer risk was higher still in late-eradication patients who were at high risk because of older age, male sex, or ulcer complications. “The result [indicates that there is a] stronger protective role of H. pylori eradication in high-risk populations,” they said.

H. pylori eradication conveyed protection in all age groups, not just in young patients. “The highest protective effect was actually found in the 60-69 age group, with the second-highest protective effect in the 50-59 age group,” the researchers said.

The researchers were unable to determine whether treatment to eradicate H. pylori was successful or not.

This study was supported in part by China's National Health Research Institutes. No financial conflicts of interest were reported.