Effects of eradicating Helicobacter pylori on metachronous gastric cancer prevention: A systematic review and meta-analysis

J Eval Clin Pract. 2020 Feb;26(1):308-315. doi: 10.1111/jep.13179. Epub 2019 May 29.

Abstract

Background: Helicobacter pylori (H pylori) infection is closely associated with the incidence of gastric cancer. However, whether H pylori eradication prevents metachronous gastric cancer remains uncertain. The aim of our study is to assess how eradicating H pylori influences metachronous gastric cancer onset following treatment of early stage gastric cancer via endoscopic resective surgery.

Patients and methods: We performed a systematic review and meta-analysis by searching PubMed, Embase, Web of Science, and the Cochrane Library. Cohort studies and randomized controlled trials that compared individuals receiving H pylori eradication with individuals receiving placebo/nontreatment and evaluated the subsequent onset of metachronous gastric cancer as the main outcome were eligible for our study. Two authors reviewed articles and extracted data independently. Integrated results for all data were presented as risk ratio.

Results: Thirteen studies containing 3863 patients were consistent with study inclusion criteria. Of the 2480 individuals in whom H pylori was successfully eradicated, 163 (6.57%) developed metachronous gastric cancer, as compared with 176 (12.73%) out of 1383 persistently infected individuals. The pooled risk ratio of metachronous gastric cancer for these studies was 0.46 (95% CI, 0.37-0.57, P < .001), providing support for the therapeutic elimination of H pylori. Subgroup analyses yielded similar results.

Conclusion: Eradicating H pylori via therapeutic treatment can effectively reduce rates of metachronous gastric cancer, and as such, it should be implemented in H pylori-infected individuals recently treated for early stage gastric cancers via endoscopic resection.

Keywords: Helicobacter pylori; eradication therapy; metachronous gastric cancer; prevention; risk ratio.