Asia–Pacific consensus guidelines on gastric cancer prevention

Abstract

Background and Aim: Gastric cancer is a major health burden in the Asia-Pacific region but consensus on prevention strategies has been lacking. We aimed to critically evaluate strategies for preventing gastric cancer. Methods: A multidisciplinary group developed consensus statements using a Delphi approach. Relevant data were presented, and the quality of evidence, strength of recommendation, and level of consensus were graded. Results:Helicobacter pylori infection is a necessary but not sufficient causal factor for non-cardia gastric adenocarcinoma. A high intake of salt is strongly associated with gastric cancer. Fresh fruits and vegetables are protective but the use of vitamins and other dietary supplements does not prevent gastric cancer. Host-bacterial interaction in H. pylori infection results in different patterns of gastritis and differences in gastric acid secretion which determine disease outcome. A positive family history of gastric cancer is an important risk factor. Low serum pepsinogens reflect gastric atrophy and may be useful as a marker to identify populations at high risk for gastric cancer. H. pylori screening and treatment is a recommended gastric cancer risk reduction strategy in high-risk populations. H. pylori screening and treatment is most effective before atrophic gastritis has developed. It does not exclude the existing practice of gastric cancer surveillance in high-risk populations. In populations at low risk for gastric cancer, H. pylori screening is not recommended. Firstline treatment of H. pylori infection should be in accordance with national treatment guidelines. Conclusion: A strategy of H. pylori screening and eradication in high-risk populations will probably reduce gastric cancer incidence, and based on current evidence is recommended by consensus.

Clinical Characteristics and Helicobacter pylori Status of Gastric Cancer in Thailand

“…pylori screening and treatment is recommended as gastric cancer risk reduction strategy in high risk countries such as Japan, China and Korea and is most effective if screening before developing of atrophic gastritis (Fock et al, 2008). However, H. pylori screening and treatment is not recommended for gastric cancer prevention in low risk countries such as Thailand due to low cost effectiveness.…”

3rd BRAZILIAN CONSENSUS ON Helicobacter pylori

“…Even though the further advanced the existing preneoplastic condition is, the less likely it is that H pylori eradication will stop gastric cancer development (37,59) , a randomized study of patients undergoing H pylori eradication following early gastric cancer resection was able to demonstrate a reduction in the appearance of metachronous gastric cancer (66) .…”

“…In 2008, the Asia-Pacific Consensus for Gastric Cancer Prevention recommended surveying and treating the entire populations for H pylori infection in high risk regions, defined as those where the incidence of gastric cancer in the population is higher than 20/100,000 inhabitants (59) . The recently published Maastricht IV Consensus believes that this approach should be considered in other high-risk areas in the world (132) .…”

Fiberoptic Endoscopy: The Singular Transformative Event of Our Time

“…Although one could predict which ulcers would re-bleed and establish or diagnose the cause of bleeding better than what was available with contrast radiology, without therapy, endoscopic diagnosis provided no benefit in terms of overall outcomes [11,12]. Such therapy can now be applied to bleeding ulcers and esophageal varices, reducing transfusion requirements, the need for surgery, and ultimately mortality [13,14].…”