Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2014 May 20:348:g3174.
doi: 10.1136/bmj.g3174.

Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomised controlled trials

Alexander C Ford  1 , David Forman  2 , Richard H Hunt  3 , Yuhong Yuan  3 , Paul Moayyedi  3
Affiliations
Review

Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomised controlled trials

Alexander C Ford et al. BMJ. .

Abstract

Objectives: To determine whether searching for Helicobacter pylori and treating with eradication therapy leads to a reduction in incidence of gastric cancer among healthy asymptomatic infected individuals.

Design: Systematic review and meta-analysis of randomised controlled trials.

Data sources: Medline, Embase, and the Cochrane central register of controlled trials were searched through to December 2013. Conference proceedings between 2001 and 2013 were hand searched. A recursive search was performed with bibliographies of relevant studies. There were no language restrictions.

Eligibility criteria for selecting studies: Randomised 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 Helicobacter pylori but otherwise healthy and asymptomatic were eligible. The control arm had to receive placebo or no treatment. Subjects had to be followed for ≥ 2 years.

Main outcome measures: 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.

Results: The search strategy identified 1560 citations, of which six individual randomised controlled trials were eligible. Fifty one (1.6%) gastric cancers occurred among 3294 individuals who received eradication therapy versus 76 (2.4%) in 3203 control subjects (relative risk 0.66, 95% confidence interval 0.46 to 0.95), with no heterogeneity between studies (I(2)=0%, P=0.60). 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.

Conclusions: 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.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that they have no relationships with companies that might have an interest in the submitted work in the previous 3 years; their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and they have no non-financial interests that may be relevant to the submitted work.”

Figures

None
Fig 1 Flow diagram of assessment of studies identified in the systematic review
None
Fig 2 Forest plot of randomised controlled trials of H pylori eradication therapy: effect on subsequent occurrence of gastric cancer
None
Fig 3 Forest plot of randomised controlled trials of H pylori eradication therapy: effect on subsequent occurrence of gastric cancer according to presence or absence of pre-neoplastic lesions at baseline. (You 2006 and Ma 2012 study had missing data concerning presence or absence of pre-neoplastic lesions at baseline for 16 individuals, leading to the loss of one gastric cancer from the analysis)
None
Fig 4 Forest plot of randomised controlled trials of H pylori eradication therapy: effect on subsequent occurrence of gastric cancer according to anti-oxidant or vitamin use
None
Fig 5 Forest plot of randomised controlled trials of H pylori eradication therapy: effect on subsequent mortality from gastric cancer
None
Fig 6 Forest plot of randomised controlled trials of H pylori eradication therapy: effect on subsequent all cause mortality
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012, version 1.0: Cancer incidence and mortality worldwide. IARC CancerBase No 11. International Agency for Research on Cancer; 2013. Available from http:globocan.iarc.fr.
    1. Bray F, Jemal A, Grey N, Ferlay J, Forman D. Global cancer transitions according to the Human Development Index (2008-2030): a population-based study. Lancet Oncol 2012;13:790-801. - PubMed
    1. Warren JR, Marshall BJ. Unidentified curved bacilli on gastric epithelium in active chronic gastritis. Lancet 1983;321:1273-5. - PubMed
    1. Marshall BJ, Armstrong JA, McGechie DB, Glancy RJ. Attempt to fulfill Koch’s postulates for pyloric Campylobacter. Med J Aust 1985;142:436-9. - PubMed
    1. Correa P. The gastric precancerous process. Cancer Surv 1983;2:437-50.

MeSH terms