Effect of Helicobacter pylori eradication on gastric precancerous lesions: A systematic review and meta‐analysis

Abstract

BackgroundThe question of whether eradication of Helicobacter pylori (Hp) can reverse gastric precancerous lesions, including intestinal metaplasia, remains uncertain, leading to ongoing debate. Therefore, a meta‐analysis was performed to evaluate the effect of Hp eradication on gastric precancerous lesions.Materials and MethodsPubMed, Embase, Cochrane Library, Web of Science, Scopus database, and ClinicalTrials.gov were systematically searched from inception to April 2023 for studies that explored the impact of Hp eradication on gastric precancerous lesions. Risk ratios (RRs) and their 95% confidence intervals (95% CIs) were selected as the effect size. We used the random‐effects model to assess pooled data. We also performed quality assessments, subgroup analyses, and sensitivity analyses.ResultsFifteen studies were included. Compared with placebo, Hp eradication could significantly prevent the progression of gastric precancerous lesions (RR = 0.87, 95% CI: 0.81–0.94, p < 0.01) and reverse them (RR = 1.32, 95% CI: 1.17–1.50, p < 0.01). Then, specific precancerous lesions were further explored. The progression of intestinal metaplasia was significantly prevented by Hp eradication compared to placebo or no treatment (RR = 0.80, 95% CI: 0.69–0.94, p < 0.01). Moreover, compared with placebo or no treatment, Hp eradication also improved chronic atrophic gastritis (RR = 1.84, 95% CI: 1.30–2.61, p < 0.01) and intestinal metaplasia (RR = 1.41, 95% CI: 1.15–1.73, p < 0.01). However, in terms of preventing dysplasia progression (RR = 0.86, 95% CI: 0.37–2.00) and improving dysplasia (RR = 0.89, 95% CI: 0.47–1.70), Hp eradication had no advantage compared to placebo or no treatment.ConclusionsHp eradication therapy could prevent the progression of gastric precancerous lesions and reverse them. Notably, intestinal metaplasia can be reversed, but this may only be appropriate for patients with epigenetic alterations and milder lesions.

Low PGⅡ levels may indicate an increased risk of gastric mucosal intestinal metaplasia in outpatients experiencing stomach discomfort: a retrospective cross-sectional study

“…Thirdly, although the eradication of Hp has been closely linked to the prevalence of GIM [25,26], there was no observed association between Hp eradication history and the occurrence of GIM in individuals with high PG levels. Conversely, individuals with low PG levels who had undergone Hp eradication exhibited a higher incidence of GIM compared to those with high PG levels and no prior history of Hp eradication.…”

Helicobacter pylori: A Contemporary Perspective on Pathogenesis, Diagnosis and Treatment Strategies

“…Keeping in mind the individual shortcomings of each of the invasive and non-invasive examinations, a combination-based approach, such as RUT combined with histological examination and bacterial culture, for the detection of H. pylori infection may be a more suitable approach for an accurate diagnosis [ 90 ]. Such an effective diagnosis and eradication can further prevent the progression of gastric carcinogenesis and also has the potential to reverse unregulated cell growth [ 91 ].…”

“…In a recently conducted study, a novel RPA-CRISPR-Cas12a-based method was developed for the detection of virulence factors CagA and VacA and the 16S rDNA gene as well. This technique was found to be very sensitive (2 ng/microliter), and therefore, may be applied for the rapid, accurate, and sensitive detection of H. pylori in various settings ( Table 1 ) [ 91 ].…”

Impact of Helicobacter pylori and metabolic syndrome-related mast cell activation on cardiovascular diseases

“…In this regard, at the topical level, the interactions between MCs and H. pylori appear to contribute to the pathophysiology of gastritis (53), and interactions among H. pylori, gastric epithelium, and MCs through inflammatory cytokine induction contribute to H. pylorirelated gastric pathologies. While H. pylori can be eradicated by oral antibiotic administration in most patients, it is worth noting that chronic gastritis may persist even after successful H. pylori eradication regiments, particularly in the presence of chronic gastritis-related dysplasia (54,55). Thus, it is beneficial to clinical prognosis when treatments can manage the underlying inflammatory process through several possible therapeutic targets, including MCs (56).…”