Helicobacter pylori Eradication Has the Potential to Prevent Gastric Cancer: A State-of-the-Art Critique

Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany.
The American Journal of Gastroenterology (Impact Factor: 10.76). 10/2005; 100(9):2100-15. DOI: 10.1111/j.1572-0241.2005.41688.x
Source: PubMed


Helicobacter pylori infection continues to play a key role in gastric diseases. Colonization of the gastric mucosa with the bacterium invariably results in the development of chronic gastritis and subsets of patients have a progression of the chronic gastritis to either ulcer or cancer. Epidemiological evidence indicates that the proportion of all gastric cancers attributable to H. pylori infection, and hence potentially preventable upon elimination of this risk factor, is somewhere in the range of 60% to 90%. This portends significant benefit in terms of morbidity and mortality, not least in populations with high prevalence of H. pylori infection coupled with high incidence of gastric cancer. The effect of prophylactic H. pylori eradication on gastric cancer incidence in humans remains unknown, however. Results from randomized trials are eagerly awaited, but availability of strong conclusive results may take many years. A growing number of studies show considerable variation in risk for gastric cancer development, depending on H. pylori strain type and the genetic predisposition of the host. There is also a remote possibility that elimination of the infection may have adverse health implications (e.g., antibiotic resistance), and therefore "simple" risk stratification and targeted chemoprevention is required. Based on "in depth" evidence presented at this workshop, the majority of the scientific task force favored a search-and-treat strategy in first-degree relatives of gastric cancer patients and an overwhelming majority felt that a more general screen-and-treat strategy should be focused in the first instance on a population with a high incidence of H. pylori-associated diseases.

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    • "Moreover, it was proved that introduction of early effective treatment of H. pylori infection in cases of peptic ulcer disease can prevent these patients from developing gastric cancer [1] [26]. "
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    • "Intervention studies that assessed the preventative effect of H. pylori eradication on gastric cancer have been conducted in healthy individuals worldwide.13–17 In the United States and Europe, however, most studies were terminated before enrolling enough subjects for significant analysis because the incidence of gastric cancer is extremely low in these countries.18, "
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    • "Although the contribution of different viruses to the development of malignancies has been well recognized, some chronic bacterial infections are also associated with tumor formation [2]. In this context, the most prominent example is Helicobacter pylori, which is an important risk factor for gastric cancer [3, 4]. "
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