Preventing Stomach Cancer by Treating Helicobacter pylori Infection

What is the relationship between Helicobacter pylori and stomach cancer?

Helicobacter pylori bacteria and the long-term inflammation they cause are known to be the main cause of stomach cancer. Infection is widespread worldwide but most prevalent in the Far East, where stomach cancer is also most common.

2 recent studies showing the importance of Helicobacter pylori treatment for stomach cancer risk

1. Benefits in people with a family history of stomach cancer

On 30 January 2020, again, NEJMpublished this notable study investigating whether Helicobacter treatment reduced future stomach cancer risk in people at risk because a first-degree relative had the disease.

• The study enrolled 1676 people with both Helicobacter pylori infection and a first-degree family history of stomach cancer.
• In this single-center randomized (random patient selection), double-blind trial, 832 patients received treatment (30 mg lansoprazole, 1000 mg amoxicillin and 500 mg clarithromycin), while 844 controls received placebo.
• After a median of 8.2 years, stomach cancer developed in 1.2% receiving treatment versus 2.7% receiving placebo, a statistically significant difference.
• Treating Helicobacter pylori carriers with a family history reduced stomach cancer risk by 55% compared with placebo.

2. Preventing secondary cancers through Helicobacter treatment in patients already diagnosed with stomach cancer

Stomach cancer is most common in South Korea, and a large clinical study from this country was published in NEJM on 22 March 2018.

Previous studies showed that appropriate antibiotics against Helicobacter pylori reduce stomach cancer risk. This study showed a significant reduction in metachronous (second) stomach cancer among people previously treated for early-stage disease.

Note: Second cancers are divided into two categories: cancers developing at different times and sites in the same organ are called metachronous cancer . Cancers in different organs of the same person are called secondary cancer .

Today, for early-stage stomach cancer with no risk of lymph-node metastasis , the standard treatment is endoscopic resection. Because the stomach is preserved, metachronous cancers can develop at approximately 3% annually.

The study enrolled 470 early-stage stomach cancer patients treated by endoscopically scraping the tumor from the stomach's inner surface. After treatment, they were randomized to two groups, one receiving Helicobacter antibiotics and the other placebo .

After a median 5,9 years of follow-up;

• In the Helicobacter treatment group, 14 patients (7%) developed metachronous stomach cancer, while in the placebo group, 27 (13%) developed a second stomach cancer. Thus, Helicobacter treatment reduced metachronous stomach cancer risk by 50%.
• Among 327 patients in subgroup analysis, gastric atrophy improved from baseline in 48% of the treatment group and 15% of the placebo group.
• Serious side effects did not differ; mild adverse effects were more common with treatment.
• However, overall survival / life expectancy did not differ significantly.

In conclusion, this study indicates that H. pylori treatment after endoscopic surgery for early stomach cancer reduces metachronous stomach cancer risk.

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