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News

H. pylori eradication prevents gastric cancer in asymptomatic infected individuals

This week's British Medical Journal investigates H. pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals.

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Professor Alexander Ford and colleagues from Canada determined whether searching for Helicobacter pylori and treating with eradication therapy leads to a reduction in incidence of gastric cancer among healthy asymptomatic infected individuals.

The team performed a systematic review and meta-analysis of randomized controlled trials.

Medline, Embase, and the Cochrane central register of controlled trials were searched through to 2013.

Conference proceedings between 2001 and 2013 were hand searched.

The researchers performed a recursive search with bibliographies of relevant studies.

There were no language restrictions.

The team identified randomized controlled trials examining the effect of at least seven days of eradication therapy on subsequent occurrence of gastric cancer in adults who tested positive for H pylori but otherwise healthy and asymptomatic were eligible.

The control arm had to receive placebo or no treatment.

2% of gastric cancers occurred among 3294 individuals who received eradication therapy
British Medical Journal

Subjects had to be followed for ≥2 years.

The research team's primary outcome defined a priori, was the effect of eradication therapy on the subsequent occurrence of gastric cancer expressed as a relative risk of gastric cancer with 95% confidence intervals.

The search strategy identified 1560 citations, of which 6 individual randomized controlled trials were eligible.

The researchers noted that 1.6% of gastric cancers occurred among 3294 individuals who received eradication therapy versus 2.4% in 3203 control subjects, with no heterogeneity between studies.

The team noted that if the benefit of eradication therapy was assumed to persist lifelong the number needed to treat was as low as 15 for Chinese men and as high as 245 for US women.

Professor Ford's "These data provide limited, moderate quality evidence that searching for and eradicating H pylori reduces the incidence of gastric cancer in healthy asymptomatic infected Asian individuals, but these data cannot necessarily be extrapolated to other populations."

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g3174
26 May 2014

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