Oesophageal and proximal gastric adenocarcinomas are rare after detection of Helicobacter pylori infection

Abstract

Summary Background Helicobacter pylori infection is the most important risk factor for non‐proximal gastric adenocarcinoma, yet some posit it is protective against oesophageal adenocarcinoma and proximal gastric cancers. Aims To evaluate the incidence of and risk factors for future oesophageal and proximal gastric cancers, utilizing the largest North American cohort of patients with previously identified H pylori. Also to identify whether treatment and eradication of H pylori alter future oesophageal and proximal gastric cancer risk. Methods Retrospective cohort study within the Veterans Administration of 36 803 patients (median age 60.4 years; 91.8% male) with confirmed H pylori between 01 January 1994 and 31 December 2018. Primary outcome was diagnosis of future oesophageal and proximal gastric cancers. A time to event with competing risk analysis was performed, evaluating patient factors and whether the patient received H pylori treatment. Secondary analysis of those treated evaluated whether confirmed eradication was associated with cancer. Results The cumulative incidence of oesophageal and proximal gastric cancers 5, 10 and 15 years after H pylori detection was 0.145%, 0.26% and 0.34%. Risk of future oesophageal or proximal gastric cancer was similar amongst whites (reference), African Americans (SHR 0.87, 95%CI 0.57‐1.43) and American Indians (SHR 1.31, 95%CI 0.18‐9.60) but substantially reduced in those of Asian (no cases amongst 213 H pylori positive) or native Hawaiian origin (no cases amongst 295 H pylori positive) (P < .001). Increasing age (SHR 1.17 per 5 years, 95% CI: 1.09‐1.25, P < 0.001) and smoking (SHR 2.06, 95% CI: 1.33‐3.18, P = 0.001) were associated with oesophageal and proximal gastric cancers. Neither treatment of H pylori nor eradication status were associated with cancer (P > 0.20). Conclusions In the largest study of US patients with H pylori, we demonstrate that rates of oesophageal and proximal gastric cancers after treatment of H pylori are low. Older age, and smoking are associated with future cancer, whilst Asian or Native Hawaiian race are protective. H pylori treatment and eradication are not associated with future cancer.

Review: Prevention and management of gastric cancer

“…H. pylori infection increases the risk of non‐cardia GC unequivocally, whereas its protective role against esophageal adenocarcinoma and proximal GC is debatable. In a retrospective study, Kumar et al aimed to identify, in the aforementioned Veterans Health Administration cohort of patients with previously diagnosed H. pylori , the risk factors for future esophageal adenocarcinoma and cardia GC 3 . Compared with whites as the reference population, the risk of future esophageal adenocarcinoma or cardia GC was similar among African Americans (SHR: 0.87, 95% CI: 0.57‐1.43) and American Indians (SHR 1.31; 95% CI, 0.18‐9.60) but substantially reduced in Asians (no cases among 213 H. pylori ‐positive) or native Hawaiian origin (no cases among 295 H. pylori ‐positive).…”

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

“…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 ]. In a recent retrospective large cohort study from US ( n = 36,803 patients with HPI), rates of esophageal and proximal gastric cancers 5, 10 and 15 years after treatment/eradication of HPI were low—0.15%, 0.26% and 0.34%, respectively [ 255 ]. In the interpretation of the data on the relationship between HPI and GERD the type and location of HPI-induced gastritis should be taken into account.…”

The Role of Microbiota in Gastrointestinal Cancer and Cancer Treatment: Chance or Curse?

“…26 However, a large retrospective study of 36,803 US veterans could not confirm the association between either H pylori status or treatment status and EAC incidence. 27 Similarly, a Swedish nationwide, population-based cohort study (n ¼ 81,919) showed that H pylori status was associated inversely with BE, although a link with EAC incidence was not found. 28 Furthermore, studies investigating the association between H pylori and reflux disease confirmed an increased risk of erosive reflux esophagitis after H pylori eradication, but did not show an increase in GERD-related symptoms.…”