Gastroenterology

Gastroenterology

Volume 150, Issue 5, May 2016, Pages 1113-1124.e5
Gastroenterology

Original Research
Full Report: Clinical—Alimentary Tract
Association Between Helicobacter pylori Eradication and Gastric Cancer Incidence: A Systematic Review and Meta-analysis

https://doi.org/10.1053/j.gastro.2016.01.028Get rights and content
Under a Creative Commons license
open access

Background & Aims

Eradication of Helicobacter pylori infection has been reported to reduce the risk of gastric cancer among asymptomatic individuals in high-risk areas. The magnitude of benefit of H pylori eradication in populations with different levels of gastric cancer risk and in different clinical scenarios is unclear. We performed a systematic review and meta-analysis of randomized controlled trials and observational studies to investigate the effects of H pylori eradication on the incidence of gastric cancer.

Methods

We searched PubMed, Cochrane Library, and ClinicalTrials.gov, reviewing titles and abstracts of studies of the effects of eradication of H pylori infection on risk of gastric cancer, through May 2015. We also searched bibliographies of included studies, related reviews, and abstracts presented at Digestive Disease Week. Twenty-four eligible studies (22 research manuscripts and 2 abstracts) were included in our meta-analysis (715 incident gastric cancers among a total of 48,064 individuals/340,255 person-years). We assessed the effects, as well as their modification by baseline gastric cancer incidence, study design (randomized trial vs observational study), clinical scenario (asymptomatic infected individuals vs individuals after endoscopic resection of early gastric cancer), demographic characteristics of patients (age and sex), and duration of follow-up.

Results

After adjustment for baseline gastric cancer incidence, individuals with eradication of H pylori infection had a lower incidence of gastric cancer than those who did not receive eradication therapy (pooled incidence rate ratio = 0.53; 95% confidence interval: 0.44−0.64). There was little heterogeneity among studies. Baseline gastric cancer incidence modified the benefit of H pylori eradication (P = .037 for interaction); the incidence rate ratio of gastric cancer decreased in a nonlinear fashion with increasing baseline incidence of gastric cancer (P = .018, in comparison with the linear model). The benefit also modestly increased with age (P = .023 for interaction), but this might be due to correlation between age and baseline gastric cancer incidence. Eradication provided significant benefit for asymptomatic infected individuals (pooled incidence rate ratio, 0.62; 95% CI: 0.49−0.79) and individuals after endoscopic resection of gastric cancers (pooled incidence rate ratio, 0.46; 95% CI: 0.35−0.60). The benefits of H pylori eradication did not differ with study design, sex, or follow-up period.

Conclusions

In a systematic review and meta-analysis, we associated eradication of H pylori infection with a reduced incidence of gastric cancer. The benefits of eradication vary with baseline gastric cancer incidence, but apply to all levels of baseline risk.

Keywords

Stomach
Tumor
Risk Factor
Antibiotic

Abbreviations used in this paper

CI
confidence interval
RCT
randomized controlled trial

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This article has an accompanying continuing medical education activity on page e14. Learning Objective: Upon completion of this examination, successful learners will be able to: (1) estimate the benefit of Helicobacter pylori eradication on gastric cancer risk; (2) list factors that modify the effect of H pylori eradication on gastric cancer risk; (3) describe the risk reduction in gastric cancer associated with H pylori eradication.

Conflicts of interest These authors disclose the following: Dr Graham is a consultant for RedHill Biopharma regarding novel Helicobacter pylori therapies and has received research support for culture of H pylori. He is a consultant for Otsuka Pharmaceuticals regarding diagnostic breath testing and for BioGaia in relation to probiotic therapy for H pylori infection. The remaining authors disclose no conflicts.

Funding This study was supported by the Health Promotion Administration, Ministry of Health and Welfare (MOHW103-TDU-212-114009), National Taiwan University Hospital (104-P01), and National Research Program for Biopharmaceuticals (104-2325-B-002-029). The funding source had no role in study design, data collection, analysis or interpretation, report writing, or the decision to submit this paper for publication.

Author names in bold designate shared co-first authorship.

Authors share co-first authorship.