Test and treat or test and scope for Helicobacter pylori infection. Any change in gastric cancer prevention?

Loughlin, Ronan Mac; Sebastian, Shaji; O'Connor, H.J.; Buckley, Martin; O'Moráin, C

doi:10.1046/j.1365-2036.17.s2.13.x

Cited by 6 publications

(5 citation statements)

References 69 publications

(70 reference statements)

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“…The association between chronic H. pylori infection and the development of gastric cancer remains controversial [31]. Several studies have shown significant associations between H. pylori seropositivity and gastric cancer risk [9,24,30,32,33]. It is, however, not known why some individuals with H. pylori infection develop gastric cancer whereas others do not.…”

Section: Discussionmentioning

confidence: 99%

“…There is increasing evidence to suggest that certain H. pylori , containing a gene called CagA, associated with cytotoxin expression, are more strongly associated with gastric cancer. Several studies have suggested that CagA positive H. pylori are more common in patients who develop gastric cancer [32,33]. Gastric cancer is generally accepted as a multistep-progression disease from chronic gastritis, chronic atrophic gastritis, intestinal metaplasia, dysplasia and, subsequently, to cancer.…”

Section: Discussionmentioning

confidence: 99%

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Gastric cancer at a university teaching hospital in northwestern Tanzania: a retrospective review of 232 cases

et al. 2012

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BackgroundDespite marked decreases in its incidence, particularly in developed countries, gastric cancer is still the second most common tumor worldwide. There is a paucity of information regarding gastric cancer in northwestern Tanzania. This study was undertaken to describe our experience, in our local setting, on the management of gastric cancer, outlining the clinicopathological and treatment outcome of these patients and suggesting ways to improve the treatment outcome.MethodsThis was a retrospective study of histologically confirmed cases of gastric cancer seen at Bugando Medical Centre between January 2007 and December 2011. Data were retrieved from patients’ files and analyzed using SPSS computer software version 17.0.ResultsA total of 232 gastric cancer patients were enrolled in the study, representing 4.5% of all malignancies. The male to female ratio was 2.9:1. The median age of patients was 52 years. The majority of the patients (92.1%) presented late with advanced gastric cancer (Stages III and IV). Lymph node and distant metastasis at the time of diagnosis was recorded in 31.9% and 29.3% of cases, respectively. The antrum was the most frequent anatomical site (56.5%) involved and gastric adenocarcinoma (95.1%) was the most common histopathological type. Out of 232 patients, 223 (96.1%) patients underwent surgical procedures for gastric cancer of which gastro-jejunostomy was the most frequent performed surgical procedure, accounting for 53.8% of cases. The use of chemotherapy and radiotherapy was documented in 56 (24.1%) and 12 (5.1%) patients, respectively. Postoperative complication and mortality rates were 37.1% and 18.1%, respectively. According to multivariate logistic regression analysis, preoperative co-morbidity, histological grade and stage of the tumor, presence of metastases at the time of diagnosis was the main predictors of death (P <0.001). At the end of five years, only 76 (32.8%) patients were available for follow-up and the overall five-year survival rate was 6.9%. Evidence of cancer recurrence was reported in 45 (19.4%) patients. Positive resection margins, stage of the tumor and presence of metastasis at the time of diagnosis were the main predictors of local recurrence (P <0.001).ConclusionsGastric cancer in this region shows a trend towards relative young age at diagnosis and the majority of patients present late with an advanced stage. Lack of awareness of the disease, poor accessibility to health care facilities and lack of screening programs in this region may contribute to advanced disease at the time of diagnosis. There is a need for early detection, adequate treatment and proper follow-up to improve treatment outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Gastric cancer at a university teaching hospital in northwestern Tanzania: a retrospective review of 232 cases

et al. 2012

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“…150, 151 In addition to curing symptoms, test-and-treat strategies in young patients with uninvestigated dyspepsia are also likely to decrease the risk of gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma and aid the management of these important public health issues. 150 …”

Section: Role Of H Pylori In the Development Of Gastric Cancermentioning

confidence: 99%

Helicobacter Pylori “Test-and-Treat” Strategy for Management of Dyspepsia: A Comprehensive Review

Gisbert

Calvet

2013

Clinical and Translational Gastroenterology

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OBJECTIVES:Deciding on whether the Helicobacter pylori test-and-treat strategy is an appropriate diagnostic–therapeutic approach for patients with dyspepsia invites a series of questions. The aim present article addresses the test-and-treat strategy and attempts to provide practical conclusions for the clinician who diagnoses and treats patients with dyspepsia.METHODS:Bibliographical searches were performed in MEDLINE using the keywords Helicobacter pylori, test-and-treat, and dyspepsia. We focused mainly on data from randomized controlled trials (RCTs), systematic reviews, meta-analyses, cost-effectiveness analyses, and decision analyses.RESULTS:Several prospective studies and decision analyses support the use of the test-and-treat strategy, although we must be cautious when extrapolating the results from one geographical area to another. Many factors determine whether this strategy is appropriate in each particular area. The test-and-treat strategy will cure most cases of underlying peptic ulcer disease, prevent most potential cases of gastroduodenal disease, and yield symptomatic benefit in a minority of patients with functional dyspepsia. Future studies should be able to stratify dyspeptic patients according to their likelihood of improving after treatment of infection by H. pylori.CONCLUSIONS:The test-and-treat strategy will cure most cases of underlying peptic ulcer disease and prevent most potential cases of gastroduodenal disease. In addition, a minority of infected patients with functional dyspepsia will gain symptomatic benefit. Several prospective studies and decision analyses support the use of the test-and-treat strategy. The test-and-treat strategy is being reinforced by the accumulating data that support the increasingly accepted idea that “the only good H. pylori is a dead H. pylori”.

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“…weight loss, dysphagia, and anaemia) are at very low risk of malignancy and do not require endoscopic investigation. The question of management then turns on the relative costs and effectiveness of endoscopy, non‐invasive tests, and eradication of H. pylori and empiric acid suppression [17].…”

Section: Whom To Test and Treatmentioning

confidence: 99%

“…In patients under 45 years of age, initially managed without endoscopy, failure of eradication therapy or relapse of symptoms requires investigation. In areas of high prevalence of H. pylori the age cut‐off for endoscopy may need to be reduced to minimize the risk of missing early gastric cancer [17,18,21].…”

Section: Whom To Test and Treatmentioning

confidence: 99%

Trends in peptic ulcer pharmacotherapy

Sıvrı¹

2004

Fundamemntal Clinical Pharma

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Considering the diseases of the stomach and duodenum, peptic ulcer has been the one with a significant clinical impact. The pathophysiology of peptic ulcer has centred on an imbalance between aggressive and protective factors. The discovery of Helicobacter pylori as a cause of peptic ulcer has changed our approach greatly towards this disease. Despite the decreasing frequency of H. pylori-induced peptic ulcers, peptic ulcer remains a major clinical problem partly because nonsteroidal anti-inflammatory drug (NSAID)-related ulcers and hospital admissions for ulcer complications associated with NSAIDs have increased in frequency. The interaction between H. pylori and NSAIDs is one of the most controversial issues in peptic ulcer. In this article, current concepts of peptic ulcer etiopathogenesis and the management of peptic ulcer according to the etiology were reviewed.

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Test and treat or test and scope for Helicobacter pylori infection. Any change in gastric cancer prevention?

Cited by 6 publications

References 69 publications

Gastric cancer at a university teaching hospital in northwestern Tanzania: a retrospective review of 232 cases

Gastric cancer at a university teaching hospital in northwestern Tanzania: a retrospective review of 232 cases

Helicobacter Pylori “Test-and-Treat” Strategy for Management of Dyspepsia: A Comprehensive Review

Trends in peptic ulcer pharmacotherapy

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