Eradication of Helicobacter pylori prevents cancer development in subjects with mild gastric atrophy identified by serum pepsinogen levels

Abstract

A longitudinal cohort study was conducted in Helicobactor pyloriinfected middle-aged Japanese males to evaluate the preventive effects of H. pylori eradication on the development of gastric cancer according to the extent of chronic atrophic gastritis (CAG). The extent of CAG was monitored by baseline serum pepsinogen (PG) levels. We followed 3,656 subjects with persistent H. pylori infection and 473 subjects with successful H. pylori eradication for cancer development for a mean (SD) of 9.3 (0.7) years. Groups with and without extensive CAG were categorized based on PG test-positive criteria to detect extensive CAG of PG I 70 ng/ml and PG I/II ratio 3.0. During the study period, 5 and 55 gastric cancers developed in H. pylori-eradicated and the noneradicated subjects, respectively, indicating no significant reduction in cancer incidence after H. pylori eradication. Among the noneradicated subjects, 1,329 were PG test-positive and 2,327 were PG test-negative. Gastric cancer was confirmed in 30 and 25 subjects, respectively. Among subjects whose infection was eradicated, 155 were PG test-positive and 318 were PG test-negative. Of these subjects, gastric cancer was confirmed in 3 and 2 subjects, respectively. Significant reduction in cancer incidence after eradication was observed only in PG test-negative subjects (p < 0.05; log-rank test). The results of this study strongly indicate that cancer development after eradication depends on the presence of extensive CAG before eradication and that H. pylori eradication is beneficial to most PG test-negative subjects with mild CAG as defined by the aforementioned criteria. ' 2009 UICC

Incidence of and risk factors for metachronous gastric cancer after endoscopic resection and successful Helicobacter pylori eradication: results of a large-scale, multicenter cohort study in Japan

“…Several studies have reported annual incidences of MGC after H. pylori eradication, ranging from 0.1 to 0.5 % in healthy individuals or peptic ulcer patients [26][27][28][29][30][31][32][33], and from 0.8 to 4.1 % in patients after endoscopic resection for early gastric cancer [9,[11][12][13][14][15]. Individuals after endoscopic resection had a higher risk of MGC compared with those who were healthy or had peptic ulcers.…”

Gastric Cancers Emerging after H. pylori Eradication Arise Exclusively from Non-Acid-Secreting Areas

“…There have been several reports that showed the incidence and characteristic features of gastric cancer after H. pylori eradication (Take et al 2005;Kamada et al 2005;Takenaka et al 2007;Fukase et al 2008;Ogura et al 2008;Yanaoka et al 2009;de Vries et al 2009). However, many of these included cases whose cancer lesions developed relatively soon after eradication, namely within 2 years after the treatment (Take et al 2005;Kamada et al 2005;Takenaka et al 2007;Fukase et al 2008;Ogura et al 2008).…”

“…Recent studies consistently reported that H. pylori eradication had some inhibitory effects on the subsequent development of gastric cancer, at least in certain conditions (Take et al 2005;Takenaka et al 2007;Fukase et al 2008;Ogura et al 2008). However, it also has been revealed that there are sporadic cases of gastric cancer even after successful eradication (Kamada et al 2005;Yanaoka et al 2009;de Vries et al 2009). Hence, careful follow-up with endoscopic examination for possible gastric cancer is necessary even after successful eradication of H. pylori (Kamada et al 2005;de Vries et al 2009;Yanaoka et al 2009).…”

“…However, it also has been revealed that there are sporadic cases of gastric cancer even after successful eradication (Kamada et al 2005;Yanaoka et al 2009;de Vries et al 2009). Hence, careful follow-up with endoscopic examination for possible gastric cancer is necessary even after successful eradication of H. pylori (Kamada et al 2005;de Vries et al 2009;Yanaoka et al 2009). Using endoscopic surveillance after eradication, the sites where new cancer preferentially develops could be determined.…”

Endoscopic Detection of Gastric Carcinoma After Helicobacter pylori Eradication: More Difficult or Just Hype?

“…Including the reports by Yamamoto et al [1] and Matsuo et al [2], [10 studies of GC detected after Hp eradication have been published to date [3][4][5][6][7][8][9][10]. The characteristics of post-eradication GC include: (a) detection *40 months after eradication; (b) lesions are histologically well differentiated; (c) gross lesion morphology is depressed; and (d) the lesions are small (10-20 mm diameter).…”