Effectiveness of Helicobacter pylori eradication in preventing metachronous gastric cancer and preneoplastic lesions. A systematic review and meta-analysis

Abstract

Background: Helicobacter pylori is a significant risk factor for gastric cancer. Recent trials show eradication decreases the incidence of gastric cancer in patients with early-stage gastric cancer. However, data on gastric cancer prevention are inconsistent for patients with precancerous lesions such as atrophic gastritis and intestinal metaplasia. Aim: The aim of the study is to assess the efficacy of H. pylori eradication in gastric cancer prevention in patients with varying risk factors for gastric cancer at baseline. Methods: A systematic review and meta-analysis were performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. PubMed, Medline, and Google Scholar were searched from inception through March 2019 for randomized controlled trials (RCTs) studying H. pylori eradication on gastric cancer prevention. We estimated the odds ratio (OR) with 95% confidence interval (CI) for each outcome using a random-effects model. P values of less than 0.05 were considered significant. Results: Nine RCTs with total of 6967 patient were included in the analysis. There was significant reduction in gastric cancer incidence in the H. pylori group for patients with early gastric cancer status post endoscopic mucosal resection OR, 0.47; 95% CI, 0.33–0.67; P < 0.0001; I 2 = 0%. There was no difference in gastric cancer incidence in patients with atrophic gastritis and intestinal metaplasia at baseline for H. pylori arm OR, 0.67; 95% CI, 0.42–1.07; P = 0.09; I 2 = 0%). Atrophic gastritis and intestinal metaplasia improved from baseline in the H. pylori arm compared to placebo OR, 2.61; 95% CI, 1.41–4.81; P = 0.002; I2 = 88 and OR, 2.61; 95% CI, 1.66–4.11; P ≤ 0.0001; I 2 = 0%, respectively. Conclusions: H. pylori eradication is associated with reduced gastric cancer incidence in patients with early-stage gastric cancer and improvement in atrophic gastritis and intestinal metaplasia. There was no difference in gastric cancer incidence in patients with atrophic gastritis and intestinal metaplasia at baseline.

Genome-wide association studies identify miRNA-194 as a prognostic biomarker for gastrointestinal cancer by targeting ATP6V1F, PPP1R14B, BTF3L4 and SLC7A5

“…Non-coding RNA (ncRNA) constitute the majority of the human transcriptome, including a class of small ncRNAs (including miRNAs and piRNAs), lncRNAs and circular RNAs (25)(26)(27). Increasing studies have reported that miRNAs play critical roles in tumorigenesis and metastasis and could serve as diagnostic and prognostic biomarkers for cancer-related patients (28).…”

Establishment and Validation of a Pathologic Upgrade Prediction Nomogram Model for Gastric Low-Grade Intraepithelial Neoplasia Patients After the Eradication of Helicobacter pylori

“…It may be due to the fact that among the selected cases reported above those with negative HP infection or that had turned negative after treatment were not strictly screened, given that the surface erosive ulcer was reported to be closely correlated with HP infection. [18][19][20][21] Therefore, it is still doubtful whether the erosive ulcer at the lesion site in the above report above can be used as an independent risk factor if not excluding HP factors. In this study, all patients selected showed positive results in HP infection after the first examination and underwent quadruple bactericidal therapy.…”

Belgian consensus for Helicobacter pylori management 2023

“…dyspepsia (41). Other studies analysed the role of H. pylori eradication on the incidence of metachronous gastric cancer and preneoplastic lesions such as atrophic gastritis and intestinal metaplasia after treatment of early gastric cancer (41,43,44). H. pylori eradication appeared to be associated with reduced gastric cancer incidence in these patients as well as with an improvement in atrophic gastritis and intestinal metaplasia.…”