Table 4

Helicobacter pylori and gastric cancer—key statements relevant for prevention strategies

StatementLevel of evidenceGrade of recommendation
Helicobacter pylori infection is the most consistent risk factor for gastric cancer. Its elimination is therefore the most promising strategy to reduce the incidence of gastric cancer1aA
The influence of environmental factors is subordinate to the effect of H pylori infection1aA
H pylori eradication abolishes the inflammatory response and slows or may arrest the progression of atrophy. In some cases it may reserve atrophy1aA
There is strong evidence that H pylori eradication reduces the risk of gastric cancer development1cA
The risk of gastric cancer can be reduced more effectively by employing eradication treatment before the development of preneoplastic conditions1aA
H pylori eradication for gastric cancer prevention is cost-effective in certain communities with a high risk for gastric cancer3B
H pylori eradication offers additional clinical and financial benefits in addition to gastric cancer preventionvaries with disease (1a to 4)A
A screen-and-treat strategy of H pylori should be explored in communities with a significant burden of gastric cancer2cA
Validated serological tests for H pylori and markers of atrophy (ie, pepsinogens) are the best available non-invasive tests to identify subjects at high risk of gastric cancer1aB
H pylori eradication to prevent gastric cancer should be undertaken in populations at high risk1cA
Preneoplastic high-risk conditions require endoscopic follow- up. Prospective studies are needed to determine the correct timing of follow-up2cA