Gastroenterology

Gastroenterology

Volume 155, Issue 1, July 2018, Pages 67-75
Gastroenterology

Original Research
Full Report: Clinical—Alimentary Tract
Effects of Helicobacter pylori Treatment on Incidence of Gastric Cancer in Older Individuals

https://doi.org/10.1053/j.gastro.2018.03.028Get rights and content

Background & Aims

Although eradication of Helicobacter pylori infection reduces the risk of gastric cancer, few data are available on its effects in older subjects. We compared the age-specific risk of gastric cancer in a large cohort of subjects who received H pylori eradication therapy vs a matched general population.

Methods

We searched the Hospital Authority database of Hong Kong to identify individuals with H pylori infection who had received a course of clarithromycin-containing eradication therapy from January 2003 through December 2012. We compared the gastric cancer incidence in this cohort with the expected incidence for the local general population by retrieving the gastric cancer incidence of the age- and sex-matched population from 2003 through 2014 (the latest available year) from the Hong Kong Cancer Registry. The primary outcome was the incidence of gastric cancer development in the cohort treated for H pylori infection vs the expected number of gastric cancer cases in the general population. Analyses were conducted by a priori age groups of less than 40 years, 40–59 years, and 60 years or older.

Results

Among 73,237 subjects infected with H pylori who received eradication therapy, 200 (0.27%) developed gastric cancer during a median follow-up time of 7.6 years. Compared with the matched general population, the gastric cancer risk was significantly lower in subjects 60 years or older who had received H pylori treatment (standardized incidence ratio [SIR], 0.82; 95% confidence interval [CI], 0.69–0.97; P = .02) but not in younger groups. When data were stratified based on time from H pylori treatment (less than 5 years, 5–9 years, and 10 or more years), the risk of gastric cancer was significantly lower than the general population 10 or more years after eradication in the group 40–59 years old (SIR 0.32; 95% CI, 0.08–0.88; P = .04) and the group 60 years or older (SIR, 0.42; 95% CI, 0.42–0.84; P = .02) than the other age groups.

Conclusions

In an analysis of data from a public hospital database on Hong Kong, we associated treatment of H pylori infection with a lower risk of gastric cancer, particularly in older subjects, 10 or more years after treatment.

Section snippets

Study Design and Data Source

We identified subjects who had received a course of clarithromycin-containing triple therapy for H pylori infection between January 2003 and December 2012 in all public hospitals managed by the Hospital Authority in Hong Kong.13 The Hospital Authority is the sole public health service provider, serving a local population of 7.3 million under a heavily subsidized public health care system.14 It manages 87% of all hospital beds in Hong Kong and has more than 7.5 million outpatient specialist

Gastric Cancer Risk in the H pylori–Treated Cohorts

A total of 73,237 patients had received a course of clarithromycin-containing triple therapy for H pylori during the study period. The baseline characteristics of these patients are shown in Table 1. Among them, 9,840 (13.4%) patients needed retreatment for H pylori, including 130 patients who needed third-line therapy. The median duration from the time of prescription of clarithromycin-containing triple therapy to the second-line and third-line therapy was 1.5 years (interquartile range [IQR],

Discussion

The results from this territory-wide study from Hong Kong provide strong support that H pylori treatment, even when given to those 60 years or older, who are the highest-risk group, could still lower the risk of gastric cancer development. When compared with a matched general population, which comprises both H pylori–infected and noninfected individuals, the risk of gastric cancer was reduced by 18% in the older (≥60 years) age group who had received H pylori treatment. When further stratified

References (23)

  • Hong Kong Hospital Authority

    Hong Kong cancer registry [Internet]

    (2017)
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    Author contributions Wai K. Leung was responsible for the conception and design of this study, data interpretation, and drafting of the manuscript. Esther W. Chan, Angel Y.S. Wong, and Lijia J. Chen were involved in data collection. Irene O.L. Wong, Ka Shing Cheung, and Kar Fu Yeung were involved in data analysis, data interpretation, and drafting of the manuscript. Ian C.K. Wong and David Y. Graham were responsible for data interpretation and critical review of the manuscript.

    Conflicts of interest The authors disclose no conflicts.

    Funding Wai K. Leung has received honoraria for attending advisory board meetings of Takeda and Abbot Laboratories.

    Author names in bold designate shared co-first authorship.

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