Effect of <i>Helicobacter pylori</i> Eradication on Metachronous Gastric Cancer after Endoscopic Resection of Gastric Tumors: A Meta‐Analysis

Yoon, Seung Bae; Park, Jae Myung; Lim, Chul-Hyun; Cho, Yu Kyung

doi:10.1111/hel.12146

Cited by 135 publications

(94 citation statements)

References 45 publications

(80 reference statements)

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“…Th e most inclusive analysis by Yoon et al ( 33 ) included 13 studies (three prospective and 10 retrospective) comprising 6687 patients. Th e pooled OR of gastric cancer in patients successfully cured of H. pylori was 0.42 (95% CI 0.32-0.56); in a subgroup analysis of the three prospective studies, the OR was 0.39 (95% CI 0.20-0.75) ( 33,34 ). Th e other two meta-analyses yielded similar results ( 31,32 ).…”

Section: Early Gastric Cancermentioning

confidence: 69%

“…Th ree recent meta-analyses have each found that the incidence of metachronous gastric cancer following the endoscopic resection of a gastric neoplasm was reduced by the eradication of H. pylori infection (31)(32)(33). Th e most inclusive analysis by Yoon et al ( 33 ) included 13 studies (three prospective and 10 retrospective) comprising 6687 patients.…”

Section: Early Gastric Cancermentioning

confidence: 99%

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ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

Chey

Leontiadis

Howden

et al. 2017

American Journal of Gastroenterology

1,262

1,505

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Helicobacter pylori ( H. pylori ) infection is a common worldwide infection that is an important cause of peptic ulcer disease and gastric cancer. H. pylori may also have a role in uninvestigated and functional dyspepsia, ulcer risk in patients taking low-dose aspirin or starting therapy with a non-steroidal anti-infl ammatory medication, unexplained iron defi ciency anemia, and idiopathic thrombocytopenic purpura. While choosing a treatment regimen for H. pylori , patients should be asked about previous antibiotic exposure and this information should be incorporated into the decision-making process. For fi rst-line treatment, clarithromycin triple therapy should be confi ned to patients with no previous history of macrolide exposure who reside in areas where clarithromycin resistance amongst H. pylori isolates is known to be low. Most patients will be better served by fi rst-line treatment with bismuth quadruple therapy or concomitant therapy consisting of a PPI, clarithromycin, amoxicillin, and metronidazole. When fi rst-line therapy fails, a salvage regimen should avoid antibiotics that were previously used. If a patient received a fi rst-line treatment containing clarithromycin, bismuth quadruple therapy or levofl oxacin salvage regimens are the preferred treatment options. If a patient received fi rst-line bismuth quadruple therapy, clarithromycin or levofl oxacin-containing salvage regimens are the preferred treatment options. Details regarding the drugs, doses and durations of the recommended and suggested fi rst-line and salvage regimens can be found in the guideline. Asia and Central and South America ( 8,22 ). Th ere is, however, preliminary evidence that it may be falling in some previously high prevalence areas ( 22 ). People immigrating to North America from Asia and other parts of the world have a much higher prevalence of the infection than people born in North America ( 23 ). In one study, the seroprevalence among immigrants from East Asia was 70.1% ( 24 ). Hispanic immigrants to North America have higher rates of the infection than fi rst-or second-generation Hispanics who were born here ( 25 ). QUESTION 2: WHAT ARE THE INDICATIONS TO TEST FOR, AND TO TREAT, H. PYLORI INFECTION? RecommendationsSince all patients with a positive test of active infection with H. pylori should be off ered treatment, the critical issue is which patients should be tested for the infection (strong recommendation, quality of evidence: not applicable), All patients with active peptic ulcer disease (PUD), a past history of PUD (unless previous cure of H. pylori infection has been documented), low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma, or a history of endoscopic resection of early gastric cancer (EGC) should be tested for H. pylori infection. Th ose who test positive should be off ered treatment for the infection (strong recommendation, quality of evidence: high for active or history of PUD, low for MALT lymphoma, low for history of endoscopic resection of EGC).In patients with uninvestigated d...

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Section: Early Gastric Cancermentioning

confidence: 69%

Section: Early Gastric Cancermentioning

confidence: 99%

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

Chey

Leontiadis

Howden

et al. 2017

American Journal of Gastroenterology

1,262

1,505

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“…The incidence of AG decreased from 59.9 to 13.7 %, while the incidence of both IM and DYS increased from 40.1 to 56.1 % [14]. On the other hand, in patients without history of GC, several reports have shown the close correlation between H. pylori infection and metachronous GC occurrence [21,[25][26][27], however, most of them also emphasized that limited effect of eradication therapy in prevention of metachronous GC, especially in patients with IM nor DYS [28].Therefore, we believed that overall reduction of GC incidence is mainly due to the retaining of progression in patients with baseline diagnosis \IM, and malignancy transformation could hardly be prevented in those with IM or DYS. Prospective studies, especially RCTs, which regarded the occurrence of GC as primary outcome were few, because the gastric carcinogenesis was time-consuming process which need long-term follow-up.…”

Section: Discussionmentioning

confidence: 95%

“…Thus, we still considered the occurrence of metachronous GC as part of our analysis. Although these conclusion have been supported by several meta-analyses [21], the controversies still exist regarding whether H. pylori eradication would be sufficient to prevent GC. For example, even with a similar research design, opposite conclusions were still drawn from these RCTs [6,10,19].…”

Section: Discussionmentioning

confidence: 99%

Helicobacter pylori eradication cannot reduce the risk of gastric cancer in patients with intestinal metaplasia and dysplasia: evidence from a meta-analysis

et al. 2015

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Background The effect of Helicobacter pylori (H. pylori) eradication on gastric cancer (GC) prevention is controversial. Intestinal metaplasia (IM) seems to be a ''point of no return'' in the precancerous cascade. We performed a meta-analysis of randomized controlled trials (RCTs) to illustrate this issue. Materials and Methods The MEDLINE, EMBASE, Cochrane Library were searched for relevant RCTs that were published in any language up to March 2014. By dividing participants into subgroups based on their baseline diagnoses as group \IM (normal, non-atrophic gastritis, atrophic gastritis) and group CIM(intestinal metaplasia, dysplasia), the relative risk (RR) of GC in each study compared treatment group with control group were pooled using Mantel-Haenszel fixed-effect model and publication bias analyses were performed.Results Ten studies from eight RCTs were included in this analysis, for a total of 7,955 participants. H. pylori treatment compared with control significantly reduced the risk of GC, with a pooled RR of 0.64 (95 % CI, 0.48-0.85). Subgroup analysis for patients with non-atrophic gastritis, atrophic gastritis (\IM) yielded a similar results (RR = 0.25, 95 % CI, 0.08-0.81). But this difference was not observed in patients with intestinal metaplasia, dysplasia (CIM) (RR = 0.88; 95 % CI, 0.59-1.31). Conclusions Our results suggested that patients with Intestinal metaplasia or dysplasia could not benefit from the H. pylori treatment on the risk of GC.

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“…Although there is a close relationship between H. pylori infection and gastric cancer, the effectiveness of eradicating the bacteria in preventing gastric cancer remains controversial [8,9,10]. There have been some reports of metachronous gastric cancer development after the eradication of H. pylori [11,12,13]. In addition, some studies have investigated changes in the health of the gastric mucosa, such as the severities of atrophic gastritis and intestinal metaplasia, after H. pylori eradication [14,15,16,17].…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological Assessment of Gastric Xanthoma as Potential Predictive Marker of Gastric Cancer

Kitamura¹,

Muguruma²,

Okamoto³

et al. 2017

Digestion

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Background/Aims: Gastric xanthomas are frequently observed in the stomach as small yellowish plaques or nodules. A close relationship among Helicobacter pylori infection, atrophic gastritis, and xanthomas has been reported. We assessed the clinicopathological features of gastric cancer with or without xanthomas. Methods: A total of 91 patients who were diagnosed as having early gastric cancer were enrolled. We evaluated the gastritis status using scores for gastritis and atrophy, positivity of H. pylori infection, the prevalence rate of xanthomas, and the clinicopathological features of gastric cancer. Results: Gastric xanthomas were observed in 72.5% of early gastric cancer cases. Scores for gastritis and atrophy were significantly higher in the xanthoma-positive group than those in the xanthoma-negative group. A higher prevalence of differentiated-type adenocarcinoma was found in the xanthoma-positive group. Among the cases with multiple gastric xanthomas, the prevalence of males was significantly higher than that of females. Conclusion: A high prevalence rate of gastric xanthomas in gastric cancer cases was shown. Xanthomas were highly associated with age, the severities of gastritis and atrophy, and differentiated-type adenocarcinoma. Regardless of the eradication of H. pylori, xanthomas may be useful predictive markers for the development of differentiated-type adenocarcinoma.

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Effect of Helicobacter pylori Eradication on Metachronous Gastric Cancer after Endoscopic Resection of Gastric Tumors: A Meta‐Analysis

Abstract: Helicobacter pylori eradication reduces the occurrence of metachronous gastric cancer in patients who have undergone endoscopic resection.

Cited by 135 publications

References 45 publications

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

Helicobacter pylori eradication cannot reduce the risk of gastric cancer in patients with intestinal metaplasia and dysplasia: evidence from a meta-analysis

Clinicopathological Assessment of Gastric Xanthoma as Potential Predictive Marker of Gastric Cancer

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