Effects of Helicobacter pylori treatment and vitamin and garlic supplementation on gastric cancer incidence and mortality: follow-up of a randomized intervention trial
AbstractObjectiveTo assess the effects of Helicobacter pylori treatment, vitamin supplementation, and garlic supplementation in the prevention of gastric cancer.DesignBlinded randomized placebo controlled trial.SettingLinqu County, Shandong province, China.Participants3365 residents of a high risk r...
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| Published in | BMJ (Online) Vol. 366; p. l5016 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
BMJ Publishing Group LTD
11.09.2019
BMJ Publishing Group Ltd |
| Subjects | |
| Online Access | Get full text |
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| Abstract | AbstractObjectiveTo assess the effects of Helicobacter pylori treatment, vitamin supplementation, and garlic supplementation in the prevention of gastric cancer.DesignBlinded randomized placebo controlled trial.SettingLinqu County, Shandong province, China.Participants3365 residents of a high risk region for gastric cancer. 2258 participants seropositive for antibodies to H pylori were randomly assigned to H pylori treatment, vitamin supplementation, garlic supplementation, or their placebos in a 2×2×2 factorial design, and 1107 H pylori seronegative participants were randomly assigned to vitamin supplementation, garlic supplementation, or their placebos in a 2×2 factorial design.InterventionsH pylori treatment with amoxicillin and omeprazole for two weeks; vitamin (C, E, and selenium) and garlic (extract and oil) supplementation for 7.3 years (1995-2003).Main outcome measuresPrimary outcomes were cumulative incidence of gastric cancer identified through scheduled gastroscopies and active clinical follow-up through 2017, and deaths due to gastric cancer ascertained from death certificates and hospital records. Secondary outcomes were associations with other cause specific deaths, including cancers or cardiovascular disease.Results151 incident cases of gastric cancer and 94 deaths from gastric cancer were identified during 1995-2017. A protective effect of H pylori treatment on gastric cancer incidence persisted 22 years post-intervention (odds ratio 0.48, 95% confidence interval 0.32 to 0.71). Incidence decreased significantly with vitamin supplementation but not with garlic supplementation (0.64, 0.46 to 0.91 and 0.81, 0.57 to 1.13, respectively). All three interventions showed significant reductions in gastric cancer mortality: fully adjusted hazard ratio for H pylori treatment was 0.62 (95% confidence interval 0.39 to 0.99), for vitamin supplementation was 0.48 (0.31 to 0.75), and for garlic supplementation was 0.66 (0.43 to 1.00). Effects of H pylori treatment on both gastric cancer incidence and mortality and of vitamin supplementation on gastric cancer mortality appeared early, but the effects of vitamin supplementation on gastric cancer incidence and of garlic supplementation only appeared later. No statistically significant associations were found between interventions and other cancers or cardiovascular disease.ConclusionsH pylori treatment for two weeks and vitamin or garlic supplementation for seven years were associated with a statistically significant reduced risk of death due to gastric cancer for more than 22 years. H pylori treatment and vitamin supplementation were also associated with a statistically significantly reduced incidence of gastric cancer.Trial registrationClinicalTrials.gov NCT00339768. |
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| AbstractList | To assess the effects of Helicobacter pylori treatment, vitamin supplementation, and garlic supplementation in the prevention of gastric cancer.OBJECTIVETo assess the effects of Helicobacter pylori treatment, vitamin supplementation, and garlic supplementation in the prevention of gastric cancer.Blinded randomized placebo controlled trial.DESIGNBlinded randomized placebo controlled trial.Linqu County, Shandong province, China.SETTINGLinqu County, Shandong province, China.3365 residents of a high risk region for gastric cancer. 2258 participants seropositive for antibodies to H pylori were randomly assigned to H pylori treatment, vitamin supplementation, garlic supplementation, or their placebos in a 2×2×2 factorial design, and 1107 H pylori seronegative participants were randomly assigned to vitamin supplementation, garlic supplementation, or their placebos in a 2×2 factorial design.PARTICIPANTS3365 residents of a high risk region for gastric cancer. 2258 participants seropositive for antibodies to H pylori were randomly assigned to H pylori treatment, vitamin supplementation, garlic supplementation, or their placebos in a 2×2×2 factorial design, and 1107 H pylori seronegative participants were randomly assigned to vitamin supplementation, garlic supplementation, or their placebos in a 2×2 factorial design.H pylori treatment with amoxicillin and omeprazole for two weeks; vitamin (C, E, and selenium) and garlic (extract and oil) supplementation for 7.3 years (1995-2003).INTERVENTIONSH pylori treatment with amoxicillin and omeprazole for two weeks; vitamin (C, E, and selenium) and garlic (extract and oil) supplementation for 7.3 years (1995-2003).Primary outcomes were cumulative incidence of gastric cancer identified through scheduled gastroscopies and active clinical follow-up through 2017, and deaths due to gastric cancer ascertained from death certificates and hospital records. Secondary outcomes were associations with other cause specific deaths, including cancers or cardiovascular disease.MAIN OUTCOME MEASURESPrimary outcomes were cumulative incidence of gastric cancer identified through scheduled gastroscopies and active clinical follow-up through 2017, and deaths due to gastric cancer ascertained from death certificates and hospital records. Secondary outcomes were associations with other cause specific deaths, including cancers or cardiovascular disease.151 incident cases of gastric cancer and 94 deaths from gastric cancer were identified during 1995-2017. A protective effect of H pylori treatment on gastric cancer incidence persisted 22 years post-intervention (odds ratio 0.48, 95% confidence interval 0.32 to 0.71). Incidence decreased significantly with vitamin supplementation but not with garlic supplementation (0.64, 0.46 to 0.91 and 0.81, 0.57 to 1.13, respectively). All three interventions showed significant reductions in gastric cancer mortality: fully adjusted hazard ratio for H pylori treatment was 0.62 (95% confidence interval 0.39 to 0.99), for vitamin supplementation was 0.48 (0.31 to 0.75), and for garlic supplementation was 0.66 (0.43 to 1.00). Effects of H pylori treatment on both gastric cancer incidence and mortality and of vitamin supplementation on gastric cancer mortality appeared early, but the effects of vitamin supplementation on gastric cancer incidence and of garlic supplementation only appeared later. No statistically significant associations were found between interventions and other cancers or cardiovascular disease.RESULTS151 incident cases of gastric cancer and 94 deaths from gastric cancer were identified during 1995-2017. A protective effect of H pylori treatment on gastric cancer incidence persisted 22 years post-intervention (odds ratio 0.48, 95% confidence interval 0.32 to 0.71). Incidence decreased significantly with vitamin supplementation but not with garlic supplementation (0.64, 0.46 to 0.91 and 0.81, 0.57 to 1.13, respectively). All three interventions showed significant reductions in gastric cancer mortality: fully adjusted hazard ratio for H pylori treatment was 0.62 (95% confidence interval 0.39 to 0.99), for vitamin supplementation was 0.48 (0.31 to 0.75), and for garlic supplementation was 0.66 (0.43 to 1.00). Effects of H pylori treatment on both gastric cancer incidence and mortality and of vitamin supplementation on gastric cancer mortality appeared early, but the effects of vitamin supplementation on gastric cancer incidence and of garlic supplementation only appeared later. No statistically significant associations were found between interventions and other cancers or cardiovascular disease.H pylori treatment for two weeks and vitamin or garlic supplementation for seven years were associated with a statistically significant reduced risk of death due to gastric cancer for more than 22 years. H pylori treatment and vitamin supplementation were also associated with a statistically significantly reduced incidence of gastric cancer.CONCLUSIONSH pylori treatment for two weeks and vitamin or garlic supplementation for seven years were associated with a statistically significant reduced risk of death due to gastric cancer for more than 22 years. H pylori treatment and vitamin supplementation were also associated with a statistically significantly reduced incidence of gastric cancer.ClinicalTrials.gov NCT00339768.TRIAL REGISTRATIONClinicalTrials.gov NCT00339768. ObjectiveTo assess the effects of Helicobacter pylori treatment, vitamin supplementation, and garlic supplementation in the prevention of gastric cancer.DesignBlinded randomized placebo controlled trial.SettingLinqu County, Shandong province, China.Participants3365 residents of a high risk region for gastric cancer. 2258 participants seropositive for antibodies to H pylori were randomly assigned to H pylori treatment, vitamin supplementation, garlic supplementation, or their placebos in a 2×2×2 factorial design, and 1107 H pylori seronegative participants were randomly assigned to vitamin supplementation, garlic supplementation, or their placebos in a 2×2 factorial design.InterventionsH pylori treatment with amoxicillin and omeprazole for two weeks; vitamin (C, E, and selenium) and garlic (extract and oil) supplementation for 7.3 years (1995-2003).Main outcome measuresPrimary outcomes were cumulative incidence of gastric cancer identified through scheduled gastroscopies and active clinical follow-up through 2017, and deaths due to gastric cancer ascertained from death certificates and hospital records. Secondary outcomes were associations with other cause specific deaths, including cancers or cardiovascular disease.Results151 incident cases of gastric cancer and 94 deaths from gastric cancer were identified during 1995-2017. A protective effect of H pylori treatment on gastric cancer incidence persisted 22 years post-intervention (odds ratio 0.48, 95% confidence interval 0.32 to 0.71). Incidence decreased significantly with vitamin supplementation but not with garlic supplementation (0.64, 0.46 to 0.91 and 0.81, 0.57 to 1.13, respectively). All three interventions showed significant reductions in gastric cancer mortality: fully adjusted hazard ratio for H pylori treatment was 0.62 (95% confidence interval 0.39 to 0.99), for vitamin supplementation was 0.48 (0.31 to 0.75), and for garlic supplementation was 0.66 (0.43 to 1.00). Effects of H pylori treatment on both gastric cancer incidence and mortality and of vitamin supplementation on gastric cancer mortality appeared early, but the effects of vitamin supplementation on gastric cancer incidence and of garlic supplementation only appeared later. No statistically significant associations were found between interventions and other cancers or cardiovascular disease.ConclusionsH pylori treatment for two weeks and vitamin or garlic supplementation for seven years were associated with a statistically significant reduced risk of death due to gastric cancer for more than 22 years. H pylori treatment and vitamin supplementation were also associated with a statistically significantly reduced incidence of gastric cancer.Trial registrationClinicalTrials.gov NCT00339768. To assess the effects of treatment, vitamin supplementation, and garlic supplementation in the prevention of gastric cancer. Blinded randomized placebo controlled trial. Linqu County, Shandong province, China. 3365 residents of a high risk region for gastric cancer. 2258 participants seropositive for antibodies to were randomly assigned to treatment, vitamin supplementation, garlic supplementation, or their placebos in a 2×2×2 factorial design, and 1107 seronegative participants were randomly assigned to vitamin supplementation, garlic supplementation, or their placebos in a 2×2 factorial design. treatment with amoxicillin and omeprazole for two weeks; vitamin (C, E, and selenium) and garlic (extract and oil) supplementation for 7.3 years (1995-2003). Primary outcomes were cumulative incidence of gastric cancer identified through scheduled gastroscopies and active clinical follow-up through 2017, and deaths due to gastric cancer ascertained from death certificates and hospital records. Secondary outcomes were associations with other cause specific deaths, including cancers or cardiovascular disease. 151 incident cases of gastric cancer and 94 deaths from gastric cancer were identified during 1995-2017. A protective effect of treatment on gastric cancer incidence persisted 22 years post-intervention (odds ratio 0.48, 95% confidence interval 0.32 to 0.71). Incidence decreased significantly with vitamin supplementation but not with garlic supplementation (0.64, 0.46 to 0.91 and 0.81, 0.57 to 1.13, respectively). All three interventions showed significant reductions in gastric cancer mortality: fully adjusted hazard ratio for treatment was 0.62 (95% confidence interval 0.39 to 0.99), for vitamin supplementation was 0.48 (0.31 to 0.75), and for garlic supplementation was 0.66 (0.43 to 1.00). Effects of treatment on both gastric cancer incidence and mortality and of vitamin supplementation on gastric cancer mortality appeared early, but the effects of vitamin supplementation on gastric cancer incidence and of garlic supplementation only appeared later. No statistically significant associations were found between interventions and other cancers or cardiovascular disease. treatment for two weeks and vitamin or garlic supplementation for seven years were associated with a statistically significant reduced risk of death due to gastric cancer for more than 22 years. treatment and vitamin supplementation were also associated with a statistically significantly reduced incidence of gastric cancer. ClinicalTrials.gov NCT00339768. AbstractObjectiveTo assess the effects of Helicobacter pylori treatment, vitamin supplementation, and garlic supplementation in the prevention of gastric cancer.DesignBlinded randomized placebo controlled trial.SettingLinqu County, Shandong province, China.Participants3365 residents of a high risk region for gastric cancer. 2258 participants seropositive for antibodies to H pylori were randomly assigned to H pylori treatment, vitamin supplementation, garlic supplementation, or their placebos in a 2×2×2 factorial design, and 1107 H pylori seronegative participants were randomly assigned to vitamin supplementation, garlic supplementation, or their placebos in a 2×2 factorial design.InterventionsH pylori treatment with amoxicillin and omeprazole for two weeks; vitamin (C, E, and selenium) and garlic (extract and oil) supplementation for 7.3 years (1995-2003).Main outcome measuresPrimary outcomes were cumulative incidence of gastric cancer identified through scheduled gastroscopies and active clinical follow-up through 2017, and deaths due to gastric cancer ascertained from death certificates and hospital records. Secondary outcomes were associations with other cause specific deaths, including cancers or cardiovascular disease.Results151 incident cases of gastric cancer and 94 deaths from gastric cancer were identified during 1995-2017. A protective effect of H pylori treatment on gastric cancer incidence persisted 22 years post-intervention (odds ratio 0.48, 95% confidence interval 0.32 to 0.71). Incidence decreased significantly with vitamin supplementation but not with garlic supplementation (0.64, 0.46 to 0.91 and 0.81, 0.57 to 1.13, respectively). All three interventions showed significant reductions in gastric cancer mortality: fully adjusted hazard ratio for H pylori treatment was 0.62 (95% confidence interval 0.39 to 0.99), for vitamin supplementation was 0.48 (0.31 to 0.75), and for garlic supplementation was 0.66 (0.43 to 1.00). Effects of H pylori treatment on both gastric cancer incidence and mortality and of vitamin supplementation on gastric cancer mortality appeared early, but the effects of vitamin supplementation on gastric cancer incidence and of garlic supplementation only appeared later. No statistically significant associations were found between interventions and other cancers or cardiovascular disease.ConclusionsH pylori treatment for two weeks and vitamin or garlic supplementation for seven years were associated with a statistically significant reduced risk of death due to gastric cancer for more than 22 years. H pylori treatment and vitamin supplementation were also associated with a statistically significantly reduced incidence of gastric cancer.Trial registrationClinicalTrials.gov NCT00339768. |
| Author | Zhang, Lian Han, Zhong-Xiang Zhang, Jing-Yu Zhou, Tong Blot, William J Li, Wen-Qing Gail, Mitchell H Guo, Yang Ma, Jun-Ling Shen, Lin Zhang, Yang Pan, Kai-Feng Li, Zhe-Xuan Liu, Wei-Dong Li, Ji-You You, Wei-Cheng |
| Author_xml | – sequence: 1 givenname: Wen-Qing surname: Li fullname: Li, Wen-Qing organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA – sequence: 2 givenname: Jing-Yu surname: Zhang fullname: Zhang, Jing-Yu organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA – sequence: 3 givenname: Jun-Ling surname: Ma fullname: Ma, Jun-Ling organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA – sequence: 4 givenname: Zhe-Xuan surname: Li fullname: Li, Zhe-Xuan organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA – sequence: 5 givenname: Lian surname: Zhang fullname: Zhang, Lian organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA – sequence: 6 givenname: Yang surname: Zhang fullname: Zhang, Yang organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA – sequence: 7 givenname: Yang surname: Guo fullname: Guo, Yang organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA – sequence: 8 givenname: Tong surname: Zhou fullname: Zhou, Tong organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA – sequence: 9 givenname: Ji-You surname: Li fullname: Li, Ji-You organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA – sequence: 10 givenname: Lin surname: Shen fullname: Shen, Lin organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA – sequence: 11 givenname: Wei-Dong surname: Liu fullname: Liu, Wei-Dong organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA – sequence: 12 givenname: Zhong-Xiang surname: Han fullname: Han, Zhong-Xiang organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA – sequence: 13 givenname: William J surname: Blot fullname: Blot, William J organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA – sequence: 14 givenname: Mitchell H surname: Gail fullname: Gail, Mitchell H organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA – sequence: 15 givenname: Kai-Feng orcidid: 0000-0002-3680-3126 surname: Pan fullname: Pan, Kai-Feng organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA – sequence: 16 givenname: Wei-Cheng surname: You fullname: You, Wei-Cheng organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31511230$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
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| Snippet | AbstractObjectiveTo assess the effects of Helicobacter pylori treatment, vitamin supplementation, and garlic supplementation in the prevention of gastric... To assess the effects of treatment, vitamin supplementation, and garlic supplementation in the prevention of gastric cancer. Blinded randomized placebo... ObjectiveTo assess the effects of Helicobacter pylori treatment, vitamin supplementation, and garlic supplementation in the prevention of gastric... To assess the effects of Helicobacter pylori treatment, vitamin supplementation, and garlic supplementation in the prevention of gastric cancer.OBJECTIVETo... |
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| SubjectTerms | Amoxicillin Biopsy Cardiovascular diseases Disease prevention Endoscopy Garlic Gastric cancer Gastroenterology Health risk assessment Helicobacter pylori Infections Intervention Mortality Nutrition Omeprazole Penicillin Selenium Statistical analysis Supplements Vitamin C Vitamin E |
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| Title | Effects of Helicobacter pylori treatment and vitamin and garlic supplementation on gastric cancer incidence and mortality: follow-up of a randomized intervention trial |
| URI | https://bmj.com/content/366/bmj.l5016.full https://www.ncbi.nlm.nih.gov/pubmed/31511230 https://www.proquest.com/docview/2288581815 https://www.proquest.com/docview/2289567607 https://pubmed.ncbi.nlm.nih.gov/PMC6737461 |
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