Helicobacter pylori eradication treatment and the risk of Barrett's esophagus and esophageal adenocarcinoma

Abstract

Background Helicobacter pylori (H. pylori) is associated with lower risks of Barrett's esophagus and esophageal adenocarcinoma, but whether H. pylori eradication increases the risk of these conditions is unknown. This study aimed to test the hypothesis that H. pylori eradication leads to gradually increased risks of Barrett's esophagus and esophageal adenocarcinoma over time, while esophageal squamous cell carcinoma was assessed for comparison reasons. Material and Methods This Swedish nationwide, population‐based cohort study in 2005‐2012 used data from the Swedish Prescribed Drug Registry to assess eradication treatment for H. pylori. Barrett's esophagus was identified from the Swedish Patient Registry, and esophageal adenocarcinoma and squamous cell carcinoma from the Swedish Cancer Registry. Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were calculated by dividing the observed risk in the H. pylori eradication treatment cohort by the expected risk derived from the Swedish population of the same age, sex, and calendar period. Results The cohort included 81 919 patients having had eradication treatment. For Barrett's esophagus (n = 178), the overall SIR was increased (SIR 3.67, 95% CI 3.15‐4.25), but the SIRs slightly decreased over time after eradication treatment. For esophageal adenocarcinoma (n = 11), the overall SIR was 1.26 (95% CI 0.62‐2.26), and the SIRs did not increase over time. The SIRs of esophageal squamous cell carcinoma (n = 10) were not influenced by eradication treatment. Conclusions This study did not provide any evidence of an increasing risk of Barrett's esophagus or esophageal adenocarcinoma (or esophageal squamous cell carcinoma) over time after eradication treatment for H. pylori.

Mass eradication ofHelicobacter pylorito reduce gastric cancer incidence and mortality: a long-term cohort study on Matsu Islands

“…For example, because eradication of H. pylori infection can restore or improve gastric acid secretion, it has been postulated that it may increase acid reflux to the oesophagus and even lead to an increase in oesophageal adenocarcinoma. 14 Antibiotic treatment also has the potential to disrupt the gut microbiota, which might produce unknown consequences. 15 Finally, there is concern regarding its effect on global antimicrobial resistance or emergence of antibiotic-resistant strains of H. pylori.…”

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

“…Six meta-analyses on association of HPI and esophageal adenocarcinoma indicated an inverse relationship [ 238 ], whereas a recent meta-analysis (35 studies including 345,886 patients) did not find such association, except the Middle East data [ 239 ]. Other researchers concluded that presence of HPI might aggravate GERD [ 240 ], or, at least, is not “protective” against GERD, as the incidence of GERD and its sequelae in patients with HPI is higher than that after eradication of the infection [ 241 , 242 ], HPI eradication improves GERD symptoms and esophagitis [ 243 , 244 , 245 , 246 , 247 ] and does not increase the risk of BO [ 248 , 249 , 250 ]. Meta-analyses on effect of eradication HPI produced, however, inconsistent results [ 229 ]: a significantly higher risk of developing de novo GERD was demonstrated in Asian studies [ 251 ], but not in Western ones [ 252 , 253 , 254 ].…”

Review ‐ Helicobacter pylori and non‐malignant upper gastro‐intestinal diseases

“…The SIRs of esophageal squamous cell carcinoma (n = 10) were not influenced by eradication treatment. The authors conclude that there is no evidence of an increased risk of Barrett's esophagus or esophageal cancer after H pylori eradication treatment 5 . Furthermore, a Brazilian cohort was analysed retrospectively to determine the impact of H pylori infection on the development of Barrett's esophagus.…”