The Pharmaceutical Journal
Vol 272 No 7294 p436
10 April 2004

This article
Reprint
Photocopy

PDF 35K, Acrobat Reader

Treatment of chronic H pylori infection reduces gastric cancer risk

POEM series

Clinical question Does treatment of Helicobacter pylori infection reduce the risk of gastric cancer?

Bottom line Asymptomatic carriers of H pylori with no endoscopically determined precancerous gastric lesions are less likely to develop gastric cancer after eradication treatment. For most primary care clinicians, these patients will rarely, if ever, fall under their purview (most tests are ordered for symptomatic patients). We will need more evidence regarding long-term outcomes and cost/benefit analyses before we can justifiably screen all adults for H pylori infection.

Synopsis Although chronic H pylori infection is associated with an increased risk of gastric cancer, it is uncertain whether treatment reduces risk. A total of 1,630 healthy, asymptomatic, adult carriers of H pylori were identified by screening in the Fuzian Province of China, a high-risk area. All subjects underwent endoscopy and 988 did not have precancerous lesions on study entry. Patients were randomly assigned in a double-blind fashion (uncertain allocation assignment) to receive H pylori eradication treatment with a two-week course of 20mg omeprazole, a 750mg combination product of amoxicillin and clavulanic acid (Augmentin), and 400mg metronidazole, all twice daily, or placebo. Individuals assessing outcomes were blinded to treatment group assignment. Ninety per cent of patients were available for the primary analysis after eight years of follow-up. A total of 18 new cases of gastric cancer were diagnosed. There was no significant reduced risk of cancer development in participants who received H pylori eradication treatment compared with those who did not (seven cases versus 11 cases; P=0.33). In the subgroup of subjects with no precancerous lesions on presentation, H pylori eradication treatment did significantly reduce the risk of gastric cancer compared with placebo (0 cases versus six cases; P=0.02).

Level of Evidence 1b- (individual randomised controlled trial with narrow confidence interval).

Reference Wong BC, Lam SK, Wong WM, et al. Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China. A randomized controlled trial. JAMA 2004;291;187–94

POEM (Patient Oriented Evidence that Matters) is a registered trademark of InfoPOEMs
© infoPOEMs 1995–2004