Treatments that eliminate Helicobacter pylori (H pylori) infection may offer long-term gastric cancer prevention in high-risk populations, according to study findings published in Gastroenterology.

Researchers conducted a randomized, placebo-controlled trial in the Fujian province in southern China beginning in July 1994, with a 26.5-year follow-up ending in December 2020. They randomly assigned 1630 asymptomatic individuals diagnosed with H pylori infection to receive standardized triple therapy or placebo. The treatment group (n=817) followed a 2-week course of omeprazole (20 mg), combined amoxicillin and clavulanate potassium (750 mg), and metronidazole (400 mg) each taken 2 times a day to eradicate the H pylori infection. The control group (n=813) received placebo. The primary outcome was gastric cancer incidence during follow-up. Secondary outcomes included total and cause-specific mortality.

The researchers assessed the triple therapy efficacy by conducting a C urea breath test 6 weeks following completion of treatment. Individuals who failed treatment were given the option of a 1-week course of quadruple therapy. By the end of the study, 83.7% of individuals in the active treatment group achieved complete eradication of H pylori.


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Gastric cancer occurred in 21 patients (2.57%) in the treatment cohort and 35 patients (4.31%) in the placebo cohort, demonstrating a reduction in gastric cancer incidence in those receiving H pylori treatment (hazard ratio [HR], 0.57; 95% CI, 0.33-0.98). The investigators noted significant reduction in gastric cancer risk in individuals without baseline dyspepsia or premalignant gastric lesions. They also observed decreased rates of gastric lesion progression in the treatment group compared with the placebo group (P <.05).

In the placebo group, 527 patients exhibited persistent H pylori infection, with 32 of these individuals developing gastric cancer during follow-up. In the treatment group, 625 patients demonstrated successful H pylori eradication, with 16 of these individuals developing gastric cancer. In the placebo group, gastric cancer incidence began within the first year during follow-up, whereas in the treatment group, gastric cancer incidence began after 5 years of follow-up.

At the 7.5-year follow-up, no statistically significant difference in gastric cancer incidence existed between the 2 groups; however, at the extended 11.5-year follow-up assessment, only participants in the treatment group with continued eradication of H pylori demonstrated significantly decreased risk for gastric cancer (P =.017).

“Our study provides strong evidence that H pylori eradication therapy significantly reduces the risk [for] gastric cancer development, which might be confined to the subgroup without precancerous gastric lesions at baseline,” the study authors wrote. “These findings highlight the need of prompt treatment for carriers of H pylori infection in high-risk populations, especially among those without advanced gastric lesions.”

Reference

Yan L, Chen Y, Chen F, et al. Effect of helicobacter pylori eradication on gastric cancer prevention: Updated report from a randomized controlled trial with 26.5 years of follow-up. Gastroenterology. Published online March 29, 2022. doi:10.1053/j.gastro.2022.03.039