Mototsugu Kato, MD, and Masahiro Asaka, MD, Hokkaido University Graduate School of Medicine, Sapporo, Japan, and colleagues conducted a randomised, controlled trial of 544 patients to investigate the possible prophylactic effect of H pylori eradication on the development of metachronous stomach cancer after surgery to remove early gastric cancer.

All patients were newly diagnosed and planning to have endoscopic treatment or in postresection follow-up after endoscopic treatment. Patients with early stomach cancer were randomised to receive either an H pylori eradication regimen (n = 272 patients) or no treatment (n = 272).

The eradication group received lansoprazole 30 mg BID, amoxicillin 750 mg BID, and clarithromycin 200 mg BID for 1 week. The control group received standard care but no additional treatment to eradicate H pylori. Patients were then examined endoscopically at 6, 12, 24, and 36 months to see if a new cancer had developed at a different site in the stomach.

The researchers found that, at 3-year follow-up, metachronous gastric cancer had developed in only 9 patients in the eradication group and in 24 in the control group.

Overall, the risk of developing such cancer was reduced by around two-thirds in the eradication group compared with the control group. In the eradication group, 19 (7%) of patients had diarrhoea and 32 (12%) had soft stools.

"The results of our study suggest that treatment to eradicate H pylori reduces the risk of developing new gastric carcinoma in patients who have a history of such disease and are thus at risk for developing further gastric cancers," the authors wrote.

In an accompanying comment, Nicholas Talley, MD, Mayo Clinic, Jacksonville, Florida, said, "There is better evidence that H pylori eradication can prevent mortality than there is for colonoscopy screening. Preventing gastric cancer by eradicating H pylori in high-risk regions should be a priority."


SOURCE: The Lancet

Copyright © 2009 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content.