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H. pylori Eradication Combats Metachronous Gastric Cancer

Patients with early gastric cancer who receive antibiotic treatment for Helicobacter pylori infection have a reduced risk of metachronous disease
23 Mar 2018
Aetiology, Epidemiology, Screening and Prevention;  Gastric Cancer;  Basic Scientific Principles
By Lynda Williams, Senior medwireNews Reporter

medwireNews: Treating Helicobacter pylori infection in patients with early gastric cancer halves the likelihood of subsequent cancer diagnoses, suggests research published in The New England Journal of Medicine.

"Patients with early gastric cancers that are limited to gastric mucosa or submucosa usually have an advanced loss of mucosal glandular tissue (glandular atrophy) and are at high risk for subsequent (metachronous) development of new gastric cancer", explain Il Ju Choi, from the National Cancer Center in Goyang, South Korea, and co-authors.

The team followed-up 396 patients, all of whom had current H. pylori infection, for a median of 5.9 years after endoscopic resection of early gastric cancer or high-grade adenoma. 

The co-primary endpoint of metachronous gastric cancer diagnosis was reported in 7.2% of the 194 patients who were randomly assigned to receive eradiation therapy consisting of twice-daily therapy for 1 week with the antibiotics amoxicillin 1000 mg and clarithromycin 500 mg, and the proton pump inhibitor rabeprazole 10 mg.

By comparison, 13.4% of the 202 patients who were instead assigned to receive placebo developed metachronous gastric cancer during follow-up, giving a significant hazard ratio of 0.50.

The second co-primary endpoint of improvement in the grade of glandular atrophy in the gastric corpus lesser curvature in the 3 years from baseline was also determined. Patients who received H. pylori eradication treatment were a significant 5.3 times more likely to achieve this outcome than those given placebo, at 48.4% of 157 patients versus 15.0% of 153 controls.

Patients given H. pylori eradication therapy were also significantly more likely to have an improved grade of intestinal metaplasia at the lesser curvature than controls (36.6 vs 18.3%) but the outcomes of glandular atrophy and intestinal metaplasia in the antrum did not differ between the groups.

Il Ju Choi and co-authors note that patients given the H. pylori eradication therapy were significantly more likely to report mild drug-related side effects, such as taste alteration, diarrhoea and dizziness, than controls (42.0 vs 10.2%).

However, there were no serious adverse events and the two arms showed similar numbers of prescriptions for gastrointestinal symptoms during follow-up.

Discussing the findings in a linked editorial, Peter Malfertheiner, from Otto von Guericke University Magdeburg in Germany, notes that “[t]he investigators did not address whether the recurrence of gastric cancer was prevented only in the patients with improvement in atrophic gastritis or if these events were not related.”

He muses whether H. pylori eradication reduces carcinogenesis by “abolishing persistent inflammation” or by “an alteration in the composition of the gastric microbiota because of improvement in the grade of gastric atrophy and a return toward normal gastric acid production.”

Regardless, the editorialist emphasizes that endoscopic or histologic surveillance for metachronous gastric cancer “remains mandatory” as H. pylori eradication does not completely prevent its development.

“This requirement extends to all patients with severe atrophic gastritis with or without intestinal metaplasia even after successful eradication”, writes Peter Malfertheiner. “Since the selection of eradication therapy is aimed at minimizing the development of antimicrobial resistance, bismuth-based regimens should be given preference.”

References

Choi IJ, Kook M-C, Kim Y-I, et al. Helicobacter pylori therapy for the prevention of metachronous gastric cancer. N Engl J Med; 378: 1085–1095.
DOI: 10.1056/NEJMoa1708423

Malfertheiner P. Helicobacter pylori treatment for gastric cancer prevention. N Engl J Med; 378: 1154–1156.
DOI: 10.1056/NEJMe1800147

Last update: 23 Mar 2018

medwireNews (www.medwireNews.com) is an independent medical news service provided by Springer Healthcare. © 2018 Springer Healthcare part of the Springer Nature group

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