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#Grand Rounds

Does H. pylori Treatment Reduce the Risk of Gastric Cancer in Those with a Family History?

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BACKGROUND AND PURPOSE:

  • The two main risk factors for gastric cancer are family history and Helicobacter pylori infection
  • Choi et al. (N Engl J Med, 2020) assessed whether treatment for H. pylori infection reduces the risk of gastric cancer in those with a family history

METHODS:

  • Single-center, double-blind, placebo-controlled trial (RCT)
  • Participants
    • 40 to 65 years of age
    • Confirmed H. pylori infection
    • ≥ one first-degree relative with gastric cancer
  • Interventions
    • Eradication therapy: Lansoprazole (30 mg), amoxicillin (1000 mg), and clarithromycin (500 mg), each taken twice daily for 7 days
    • Placebo
  • Primary outcome
    • Development of gastric cancer
  • Secondary outcome
    • Development of gastric cancer according to H. pylori eradication status

RESULTS:

  • 1,676 participants | Follow-up: Median 9.2 years
    • Treatment group: 832
    • Placebo group: 844  
  • Gastric cancer developed in
    • Treatment group: 1.2%
    • Placebo group: 2.7%
    • Hazard ratio (HR) 0.45 (95% CI, 0.21 to 0.94; P=0.03)
  • Among the 10 participants in the treatment group who developed gastric cancer
    • 5 (50.0%) had persistent H. pylori infection
  • Gastric cancer development stratified by eradication vs persistence of H. pylori
    • H. pylori infection eradicated: 0.8% (5 of 608)
    • Persistent H. pylori: 2.9% (28 of 979)
    • HR 0.27 (95% CI, 0.10 to 0.70)
  • Adverse events
    • Generally mild
    • More common in the treatment group (53.0%) vs placebo group (19.1%); P<0.001

CONCLUSION:

  • Authors acknowledge study limitations, such as absence of testing for genetic susceptibility
  • Eradication of H. pylori infection was effective in reducing risk for gastric cancer in individuals with family history in first degree relatives

Learn More – Primary Sources:

Family History of Gastric Cancer and Helicobacter pylori Treatment

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