Antibiotics for H pylori May Prevent Gastric Cancer

Beth Skwarecki

July 24, 2015

Eliminating the bacterium Helicobacter pylori can reduce the risk for gastric cancer in healthy individuals, according to a systematic review of six trials published online July 22 in the Cochrane Database of Systematic Reviews. The five positive trials were done in Asian populations, and the authors caution that "we cannot necessarily extrapolate this data to other populations."

Therapy to eradicate H pylori, a known cause of peptic ulcers, consists of a 1- to 2-week course of antibiotics either alone or in combination with acid suppressant therapy, bismuth, or both.

For the current review, the investigators considered randomized controlled trials that compared eradication with placebo or with no treatment. The trials included 6497 healthy, asymptomatic adults who tested positive for the presence of the bacterium. Gastric cancer was defined as any gastric adenocarcinoma, including intestinal (differentiated) or diffuse (undifferentiated) type or without specified histology.

In the antibiotic-treatment group, the incidence of gastric cancer was 51 of 3294 people compared with 76 of 3203, a risk ratio of 0.66 (95% confidence interval [CI], 0.46 - 0.95), based on moderate-quality evidence.

Only one trial reported on esophageal cancer, with two cases out of 817 patients in the treatment group compared with one in the placebo group (risk ratio [RR], 1.99; 95% CI, 0.18 - 21.91). None of the trials reported other adverse events, leading the review authors to write that "we were unable to assess the balance of benefits and harms if population screening and treatment for H. pylori infection were to be adopted as a public health measure."

The risk for death from all causes did not differ between groups (RR 1.09; 95% CI 0.86 to 1.38), and the authors could not asses the mortality risk from gastric cancer because of the wide confidence intervals (RR, 0.67; 95% CI, 0.40 - 1.11).

"The review highlights the need for further trials in different populations to provide more evidence, and these should report both the benefits and harms of such an approach," lead author Alexander Ford, MBChB, MD, from St. James's University Hospital and Leeds University in the United Kingdom, said in a journal news release.

The authors have disclosed no relevant financial relationships.

Cochrane Database Syst Rev. Published online July 22, 2015. Abstract

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