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Eradicate H. pylori Infection in Gastric Cancer Patients

Summary and Comment |
February 7, 2014

Eradicate H. pylori Infection in Gastric Cancer Patients

  1. David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

Risk for metachronous gastric cancer after endoscopic mucosal dissection for early gastric cancer was more than doubled in patients with persistent H. pylori infection.

  1. David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

Helicobacter pylorus is an established cause of gastric cancer (GC). The effect of H. pylori eradication on subsequent development of metachronous tumors or dysplasia after endoscopic resection is controversial.

Investigators at a single center in Korea retrospectively assessed whether H. pylori infection eradication was associated with reduced risk for GC or dysplasia in 283 patients treated for early GC with endoscopic mucosal dissection (ESD). All patients were treated for H. pylori infection. Treatment failed in 69 patients. All patients were followed with endoscopy at 3, 6, and 12 months, and then annually for metachronous GC or dysplasia.

After at least 3 years of follow-up, metachronous GC or dysplasia occurred in 13 of 69 (18.8%) patients with persistent H. pylori infection and in 18 of 214 (8.4%) patients with eradicated infection (P=0.016). When evaluated separately, only the incidence of GC was higher in patients with persistent infection versus those with eradicated infection (14.5% vs. 4.7%, P=0.009); rates of dysplasia did not vary. In multivariate analysis, persistent H. pylori infection and age ≥60 years were independent risk factors for metachronous lesions (hazard ratios, 2.322 and 2.803, respectively). The authors conclude that H. pylori eradication can reduce the incidence of metachronous lesions after ESD for GC and urge annual surveillance endoscopy to detect these lesions, particularly in the elderly.

Comment

These results support the universal eradication of Helicobacter pylori in patients with gastric cancer. Although there were considerably fewer patients in the H. pylori group in this retrospective study, the numbers were adequate to identify a difference of 10% in metachronous lesions between groups. Ideally, a prospective trial would randomize an equal number of patients to each group, but such a study presents ethical problems. As the authors note, larger studies in different geographic locations are indicated to confirm and refine these results.

  • Disclosures for David J. Bjorkman, MD, MSPH (HSA), SM (Epid.) at time of publication Leadership positions in professional societies World Gastroenterology Organization (Treasurer)

Citation(s):

Reader Comments (3)

MAHMOUD SAMIR ELGENDY Resident, Internal Medicine, teaching hospital ( EGYPT

very nice article and information
thank you

Ali Almfraji Physician, Internal Medicine, iraq, Kirkuk

The results of these retrospective studies are significant for the seek of patients with peptic ulcer disease and gastric cancer...
I hope this will urge gasroenterologists to emphasize more concentrated use of helicobactor pylori eradication programs
Thanx

RAJESWARI NATARAJAN retired

Being a risk for neoplasia, prevention of infection becomes important. How is the infection introduced ? Can infection be introduced when endoscope ,not properly sterilized ,is used for some other condition?

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