Eradication Therapy to Prevent Gastric Cancer in Helicobacterpylori–Positive Individuals: Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 169; no. 2; pp. 261 - 276
• Main Authors: Ford, Alexander C., Yuan, Yuhong, Park, Jin Young, Forman, David, Moayyedi, Paul
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2025
• Subjects: Anti-Bacterial Agents - therapeutic use; Endoscopic Mucosal Resection; Eradication Therapy; Gastric Cancer; Helicobacter Infections - complications; Helicobacter Infections - diagnosis; Helicobacter Infections - drug therapy; Helicobacter Infections - microbiology; Helicobacter pylori; Helicobacter pylori - drug effects; Helicobacter pylori - isolation & purification; Humans; Incidence; Meta-Analysis; Mortality; Observational Studies as Topic; Proton Pump Inhibitors - therapeutic use; Randomized Controlled Trials as Topic; Stomach Neoplasms - epidemiology; Stomach Neoplasms - microbiology; Stomach Neoplasms - mortality; Stomach Neoplasms - prevention & control; Treatment Outcome; FIT; RR; Meta-Analysis; RCT; Helicobacter pylori; NNT; Mortality; CI; Gastric Cancer; Eradication Therapy; GRADE; EMR
• ISSN: 0016-5085; 1528-0012; 1528-0012
• DOI: 10.1053/j.gastro.2024.12.033

Screening for, and treating, Helicobacter pylori in the general population or patients with early gastric neoplasia could reduce incidence of, and mortality from, gastric cancer. We updated a meta-analysis of randomized controlled trials (RCTs) examining this issue. We searched the literature through October 4, 2024, identifying studies examining effect of eradication therapy on incidence of gastric cancer in H pylori–positive adults without gastric neoplasia at baseline or H pylori–positive patients with gastric neoplasia undergoing endoscopic mucosal resection (EMR) in either RCTs or observational studies. The control arm received placebo or no eradication therapy in RCTs and no eradication therapy in observational studies. Follow-up was ≥2 years. We estimated relative risks (RR) of gastric cancer incidence and mortality. Eleven RCTs and 13 observational studies were eligible. For RCTs, RR of gastric cancer was lower with eradication therapy in healthy H pylori–positive individuals (8 RCTs, 0.64; 95% confidence interval [CI], 0.48–0.84) and H pylori–positive patients with gastric neoplasia undergoing EMR (3 RCTs, 0.52; 95% CI, 0.38–0.71). RR of death from gastric cancer was lower with eradication therapy in healthy H pylori–positive individuals (5 RCTs, 0.78; 95% CI, 0.62–0.98). In observational studies, RR of future gastric cancer was lower with eradication therapy in H pylori–positive subjects without gastric neoplasia at baseline (11 studies, 0.56; 95% CI, 0.43–0.73) and H pylori–positive patients with gastric neoplasia undergoing EMR (2 studies, 0.19; 95% CI, 0.06–0.61). This meta-analysis provides further evidence that administering eradication therapy prevents gastric cancer in H pylori–positive individuals, with consistency in results among studies of different design. [Display omitted] We studied whether treating a bacterium in the human stomach, Helicobacter pylori, reduces risk of gastric cancer. Treatment of this bacterium reduced future occurrence of gastric cancer significantly in populations at high risk.