Lessons from Ongoing Intervention Studies

Forman, David

doi:10.1007/978-94-011-4882-5_37

Cited by 22 publications

(7 citation statements)

References 11 publications

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“…It revealed the difficulty in conducting properly designed intervention study for gastric cancer: It would require enrollment of thousands subjects and last for decades. 36,37 A theoretical model estimated that in high-risk countries, a sample size of 17,625 middle-aged subjects per group and follow-up period of 10 years would be required to demonstrate 50% reduction in expected increase of gastric cancer incidence after H. pylori eradication. 38 Gastric cancer prevention studies 18 designed to evaluate the long-term effect of H. pylori eradication have had the problem that after receiving informed consent, few participants are prepared to enter the placebo arm.…”

Section: Discussionmentioning

confidence: 99%

Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial

et al. 2008

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Section: Discussionmentioning

confidence: 99%

Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial

et al. 2008

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“…Atrophic gastritis may improve on long‐term follow‐up after H. pylori eradication, which is thus strongly recommended in atrophic gastritis 32 , 91–93 (Table 1), but intestinal metaplasia may not be reversible 32 , . 94 , 95 These statements are based on level 2 evidence. It should be noted that the diagnosis of atrophic gastritis can be observer dependent and this may be contributed to by sampling error 96 …”

Section: Prevention Of Cancer and Other H Pylori‐related Gastroduodementioning

confidence: 99%

Current concepts in the management of Helicobacter pylori infection—The Maastricht 2‐2000 Consensus Report

Malfertheiner

Mégraud

O’Moráin³

et al. 2002

Aliment Pharmacol Ther

1,128

986

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Significant progress and new insights have been gained in the 4 years since the first Maastricht Consensus Report, necessitating an update of the original guidelines. To achieve this, the European Helicobacter Pylori Study Group organized a meeting of specialists and experts from around the world, representatives from National Gastroenterology Societies and general practitioners from Europe to establish updated guidelines on the current management of Helicobacter pylori infection. The meeting took place on 21–22 September 2000. A ‘test and treat’ approach is recommended in adult patients under the age of 45 years (the age cut‐off may vary locally) presenting in primary care with persistent dyspepsia, having excluded those with predominantly gastro‐oesophageal reflux disease symptoms, non‐steroidal anti‐inflammatory drug users and those with alarm symptoms. Diagnosis of infection should be by urea breath test or stool antigen test. As in the previous guidelines, the eradication of H. pylori is strongly recommended in all patients with peptic ulcer, including those with complications, in those with low‐grade gastric mucosa‐associated lymphoid tissue lymphoma, in those with atrophic gastritis and following gastric cancer resection. It is also strongly recommended in patients who are first‐degree relatives of gastric cancer patients and according to patients’ wishes after full consultation. It is advised that H. pylori eradication is considered to be an appropriate option in infected patients with functional dyspepsia, as it leads to long‐term symptom improvement in a subset of patients. There was consensus that the eradication of H. pylori is not associated with the development of gastro‐oesophageal reflux disease in most cases, and does not exacerbate existing gastro‐oesophageal reflux disease. It was agreed that the eradication of H. pylori prior to the use of non‐steroidal anti‐inflammatory drugs reduces the incidence of peptic ulcer, but does not enhance the healing of gastric or duodenal ulcer in patients receiving antisecretory therapy who continue to take non‐steroidal anti‐inflammatory drugs. Treatment should be thought of as a package which considers first‐ and second‐line eradication therapies together. First‐line therapy should be with triple therapy using a proton pump inhibitor or ranitidine bismuth citrate, combined with clarithromycin and amoxicillin or metronidazole. Second‐line therapy should use quadruple therapy with a proton pump inhibitor, bismuth, metronidazole and tetracycline. Where bismuth is not available, second‐line therapy should be with proton pump inhibitor‐based triple therapy. If second‐line quadruple therapy fails in primary care, patients should be referred to a specialist. Subsequent failures should be handled on a case‐by‐case basis by the specialist. In patients with uncomplicated duodenal ulcer, eradication therapy does not need to be followed by further antisecretory treatment. Successful eradica‐ tion should always be confirmed by urea breath test or an endoscopy‐based test i...

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“…Interventional studies would confirm whether eradication of H. pylori prevents the development of gastric cancer. However, as the disease has a relatively low incidence and a long natural history, in order to be informative these studies would need to enrol thousands of subjects and last for decades 27 . A recent theoretical model estimated that in order to demonstrate a 50% reduction in the expected increase of gastric cancer incidence after H. pylori eradication in a high‐risk country, a sample size of 17 625 middle‐aged subjects per group, followed for 10 years, would be required 28 .…”

Section: Effect Of Helicobacter Pylori Eradication On Gastric Precancmentioning

confidence: 99%

Systematic review: Helicobacter pylori eradication for the prevention of gastric cancer

Fuccio

Zagari

Minardi

et al. 2006

Aliment Pharmacol Ther

109

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Lessons from Ongoing Intervention Studies

Cited by 22 publications

References 11 publications

Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial

Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial

Current concepts in the management of Helicobacter pylori infection—The Maastricht 2‐2000 Consensus Report

Systematic review: Helicobacter pylori eradication for the prevention of gastric cancer

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