Original Contribution
The American Journal of Gastroenterology (2005) 100, 1037–1042; doi:10.1111/j.1572-0241.2005.41384.x
The Effect of Eradicating Helicobacter Pylori on the Development of Gastric Cancer in Patients with Peptic Ulcer Disease
Susumu Take MD, PhD1, Motowo Mizuno MD, PhD1, Kuniharu Ishiki MD, PhD1, Yasuhiro Nagahara MD, PhD1, Tomowo Yoshida MD, PhD1, Kenji Yokota PhD1, Keiji Oguma MD, PhD1, Hiroyuki Okada MD, PhD1 and Yasushi Shiratori MD, PhD1
1Department of Internal Medicine, Nippon Kokan Fukuyama Hospital, Daimon-cho, Fukuyama; Department of Internal Medicine, Hiroshima City Hospital, Nakaku, Hiroshima; Department of Bacteriology; and Department of Medicine and Medical Science, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
Correspondence: Motowo Mizuno, MD, PhD, Department of Internal Medicine, Hiroshima City Hospital, 7-33 Motomachi, Nakaku, Hiroshima 730-8518, Japan
Received 22 August 2004; Revised 0000; Accepted 28 November 2004.
Abstract
OBJECTIVES:
Infection with Helicobacter pylori is a risk factor for the development of gastric cancer. However, it is not known whether eradication therapy can prevent the development of gastric cancer in persons in whom the cancer is not yet established. In the present study, we investigated whether the eradication of H. pylori in patients with peptic ulcer disease reduces the likelihood of their developing gastric cancer.
METHODS:
Prospective posteradication evaluations were conducted in 1,342 consecutive patients (1,191 men and 151 women; mean age: 50 yr) with peptic ulcer diseases who had received H. pylori eradication therapy. After confirmation of eradication, endoscopy and a urea breath test were performed yearly.
RESULTS:
A total of 1,120 patients completed more than 1-yr follow-up and were followed for up to 8.6 yr (a mean of 3.4 yr). Gastric cancer developed in 8 of 944 patients cured of infection and 4 of 176 who had persistent infection (p = 0.04; log-rank test). All the gastric cancer developed in patients with gastric ulcer, but none in patients with duodenal ulcer (p = 0.005; Fisher's exact test). In patients with gastric ulcer, persistent infection was identified as a significant factor for the risk of developing gastric cancer (hazard ratio: 3.35; 95% confidence interval: 1.00–11.22; p = 0.04; Cox's proportional-hazards model).
CONCLUSION:
H. pylori eradication may reduce their risk of developing gastric cancer in patients with gastric ulcer. Large-scale studies in additional populations of this important international public-health issue are warranted.
