Does Eradication of Helicobacter pylori Lower the Chance of Gastric Cancer?
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Does Eradication of Helicobacter pylori Lower the Chance of Gastric Cancer?

Vanessa M. Shami, MD, FASGE, reviewing Li D, et al. Gastroenterology 2023 May 18.

Helicobacter pylori eradication has been shown to decrease the risk of noncardia gastric adenocarcinoma (NCGA) in Asia; however, the data in the United States are limited. This large, retrospective cohort study investigated the incidence of NCGA after H pylori eradication therapy in a community-based U.S. health care system.

More than 716,500 Kaiser Permanente Northern California members underwent testing and/or treatment for H pylori between 1997 and 2015 and were followed through December 31, 2018. Test results showed that 243,663 patients (35.5%) were positive for H pylori, and 443,361 (64.5%) were negative. The Fine-Gray subdistribution hazard model and standardized incidence ratios were used to assess the risk of NCGA. 

In H pylori-positive patients, the subdistribution hazard ratio for NCGA was 6.07 (95% confidence interval [CI], 4.20-8.76) for untreated and 2.86 (95% CI, 1.86-3.86) for treated patients when compared with H pylori-negative individuals. Subdistribution hazard ratios for NCGA in patients treated for H pylori were 0.95 (0.47-1.91) at <8 years and 0.37 (0.14-0.97) after ≥8 years of follow-up when compared with H pylori-positive individuals who were untreated. Compared with the general Kaiser Permanente population, standardized incidence ratios (95% CI) of NCGA decreased over time after H pylori treatment: 2.00 (1.79-2.24) after ≥1 year, 1.01 (0.85-1.19) after ≥4 years, 0.68 (0.54-0.85) after ≥7 years, and 0.51 (0.38-0.68) after ≥10 years.

Vanessa M. Shami, MD, FASGE

COMMENT

H pylori eradication therapy was associated with a significantly reduced incidence of NCGA after 8 years, compared with no treatment. The risk became lower for treated individuals than the general population after 7 to 10 years of follow-up. This study supports that the data from Asia are generalizable to the U.S. and that H pylori eradication decreases gastric cancer development in the U.S.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Li D, Jiang SF, Lei NY, Shah SC, Corley DA. Effect of Helicobacter pylori eradication therapy on the incidence of noncardia gastric adenocarcinoma in a large diverse population in the United States. Gastroenterology 2023 May 18. (Epub ahead of print) (https://doi.org/10.1053/j.gastro.2023.04.026)

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