Eradicating Helicobacter pylori Reduces Gastric Cancer Risk: New Evidence

Abstract

Gastric cancer (GC) is a prevalent digestive tract tumor. The Global Cancer Statistics Report (GLOBOCAN 2020) reveals 1,089,103 new cases globally, ranking fifth in incidence and fourth in mortality, with a case fatality rate of nearly 0.7 (769,000/1,089,000). 1 If uncontrolled, GC could see 1.8 million new cases and 1.3 million deaths by 2040, significantly increasing the disease burden. 2 Helicobacter pylori (H. pylori) infection is a critical risk factor for GC, with strong evidence linking it to non-cardia gastric cancer. 3,4 However, its association with car-dia gastric cancer remains inconsistent, particularly in Western populations where correlations are often absent or negative. In contrast, East Asian studies frequently show an increased cardia cancer risk with H. pylori infection. 5 Eradicating H. pylori is the most definitive and controllable factor in preventing gastric cancer , as shown by multiple clinical trials (Table 1), 4,6-11 and meta-analyses have confirmed this conclusion. 5,12-14 A meta-analysis of 10 global, randomized controlled trials observed that H. pylori eradication could decrease gastric cancer incidence (risk ratio = 0.54, 95% confidential interval (CI): 0.40-0.72) and mortality (risk ratio = 0.61, 95% CI: 0.40-0.92). 12 Another meta-analysis recruiting eight randomized controlled studies and 16 cohort studies reached a similar conclusion, indicating a 46% reduction in gastric cancer risk. 14 However, most studies included in these two meta-analyses come from East Asia, particularly China, where the baseline risk for healthy populations is relatively high. Additionally , many studies have an insufficient scale, leading to limited combined events. A recently published article in Nature Medicine has provided new evidence. Pan et al. 8 designed a prospective, randomized, controlled study. Starting in 2011 in Linqu, Shandong, this study followed 180,284 individuals aged 25-54 for up to 11.8 years. Participants with positive C13 urea breath test results were randomly assigned to undergo a standard 10-day quadruple therapy for H. pylori eradication (with 20 mg omeprazole, 750 mg tetra-cycline, 400 mg metronidazole, and 300 mg bismuth citrate). The control group received symptom relief treatment once daily using omeprazole and bismuth citrate. Over the 11.8 years of follow-up, 1,035 new gastric cancer cases were recorded. An intention-to-treat analysis revealed a significant decline in gastric cancer incidence among individuals w…