Helicobacter pylori eradication prevents secondary gastric cancer in patients with mild‐to‐moderate atrophic gastritis

Abstract

Background and Aim: Whether Helicobacter pylori eradication prevents metachronous recurrence after endoscopic resection (ER) of early gastric cancer remains controversial. This multicenter retrospective study aimed to evaluate the long-term (> 5 years) effects of H. pylori eradication by stratifying patients' baseline degrees of atrophic gastritis. Methods: A total of 483 H. pylori-positive patients who had undergone ER for early gastric cancer were divided into two groups-(i) those having undergone successful H. pylori eradication within 1 year after ER (eradicated group, n = 294) and (ii) those with failed or not attempted H. pylori eradication (non-eradicated group, n = 189). The cumulative incidences of metachronous gastric cancer between the two groups were compared for all patients, for patients with mild-to-moderate atrophic gastritis (n = 182), and for patients with severe atrophic gastritis (n = 301). Results: During a median follow-up of 5.2 years (range 1.1-14.8), metachronous cancer developed in 52 (17.7%) patients in the eradicated group and in 35 (18.5%) patients in the non-eradicated group (P = 0.11, log-rank test). In patients with mild-to-moderate atrophic gastritis (111 and 71 in the eradicated and non-eradicated groups, respectively), the cumulative incidence of metachronous cancer was significantly lower in the eradicated group than that in the non-eradicated group (P = 0.03, log-rank test). However, no significant intergroup difference was observed in patients with severe atrophic gastritis (P = 0.69, log-rank test). Conclusions: Helicobacter pylori eradication had a preventive effect on the development of metachronous gastric cancer in patients with mild-to-moderate atrophic gastritis. data. Minoru Kato analyzed and interpreted the data. Minoru Kato and Yoshito Hayashi drafted the article. Yoshiki Tsujii, Tsutomu Nishida, Hideki Iijima, and Tetsuo Takehara critically revised the article. All authors finally approved the article.

Temporal trend of gastric cancer burden along with its risk factors in China from 1990 to 2019, and projections until 2030: comparison with Japan, South Korea, and Mongolia

“…The H. pylori infection rate in Mongolia is estimated to be 74.1% [ 50 ], which is higher than China (55.8%), Japan (51.7%) and South Korea (53.9%) [ 49 ]. Robust evidence demonstrates that H. pylori eradication can reduce the incidence of GC with the relative risk of 0.54 in the healthy population, and prevent deterioration of mild-to-moderate atrophic gastritis [ 34 , 51 ], which imply expanded population screening, improving the treatment of H. pylori infection, developing effective H. pylori vaccines will reduce the rate of death and disability-adjusted life-years of GC [ 33 , 52 , 53 ]. In the current study, the GC burden due to H. pylori is not evaluated because it is not included in the GBD database.…”

AGA Clinical Practice Update on the Diagnosis and Management of Atrophic Gastritis: Expert Review

“…Nevertheless, despite persistent signs of AG, H pylori eradication does still appear to reduce the risk of gastric cancer. 74…”

Has the issue of the “point of no return” in gastric carcinogenesis already been resolved?

“…3 This "point of no return" concept raised questions about the preventative effect of H pylori eradication therapy against metachronous gastric cancer in patients who underwent endoscopic resection for gastric cancer because they usually present with advanced precancerous lesions, including metaplasia, on histologic evaluation. 4,5 However, the point-of-no-return concept has been challenged by recent studies showing the beneficial effect of H pylori eradication for the prevention of metachronous gastric cancer. [5][6][7] The severity of atrophic gastritis and intestinal metaplasia improved and the risk of metachronous gastric cancer decreased after H pylori eradication in patients with early gastric cancer.…”

“…Consequently, they concluded that the "point of no return" may no longer be an issue.Recently, Kato et al 3 extended the follow-up period of a previous study and showed that H pylori eradication after ER of EGC had a preventive effect on the development of MGC in patients with mild to moderate atrophic gastritis, but this was not observed in severe atrophy. 4 They compared patients with H pylori eradication within 1 year after ER to those without or with failed eradication. This finding can mean that atrophic severity can have interaction effects, a predictive factor of MGC, but not confounding factors as a prognostic value.…”