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Helicobacter pylori Eradication Did Not Affect Incidence of Gastric Cancer in a High-Risk Population, But Cut Risk in Those Without Precancerous Lesions

Treatment for eradication of Helicobacter pylori, compared with placebo, did not significantly alter gastric cancer incidence among a high-risk population, but did result in a significantly decreased risk of developing gastric cancer among a subgroup without precancerous lesions, according to the findings of a prospective trial of healthy H pylori carriers from Fujian Province, China.

Benjamin Chun-Yu Wong, MD, University of Hong Kong, and colleagues for the China Gastric Cancer Study Group randomly assigned 1,630 otherwise healthy H pylori carriers to receive either a 2-week course of 20 mg omeprazole, a combination product of amoxicillin and clavulanate potassium at 750 mg, and 400 mg metronidazole twice daily, or placebo. Those in the active treatment group who did not achieve H pylori eradication initially could opt for an additional week of twice daily colloidal bismuth subcitrate at 240 mg, metronidazole at 600 mg, clarithromycin at 500 mg, and omeprazole at 20 mg.

Baseline upper endoscopy results showed no precancerous lesions in 988 of the study participants. All participants received 6 month follow-ups and carbon 13 urea breath tests for H pylori at 6-weeks post treatment and annually for 7.5 years.

Successful eradication occurred after first-line treatment in 624 of the 817 in the treatment group and in 60 of the 85 individuals who opted for the second line treatment, for an overall H pylori eradication rate of 83.7% in the treatment group.

Gastric cancers developed in 0.86% of individuals in the treatment group compared with 1.35% in the placebo group. Cox regression analysis of variables that were significantly different between the groups at baseline, including alcohol use, frequent intake of fish sauce, and regular intake of fruit, had no effect on the development of gastric cancer. However, smoking had a hazard ratio of 6.2 and older age had a hazard ratio of 1.10 for the development of gastric cancer.

Among the subgroup of participants without precancerous lesions at baseline, none in the active treatment group compared with 6 in the placebo group developed gastric cancer. The researchers note that the incidence of gastric cancer in the placebo group increased rapidly after a follow-up of 72 months.

The authors conclude, "In high-risk populations, all patients with H pylori infection with no precancerous lesions should consider the use of H pylori eradication treatment for gastric cancer prevention." They add that "longer follow-up is needed to examine the effect of eradication in participants with precancerous lesions."

JAMA 2004;291:187-194.

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