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Review
. 2019 Jan;13(1):17-24.
doi: 10.1080/17474124.2019.1542299. Epub 2018 Nov 13.

The eradication of Helicobacter pylori to prevent gastric cancer: a critical appraisal

Jeng-Yih Wu  1   2 , Yi-Chia Lee  3   4   5 , David Y Graham  6
Affiliations
Review

The eradication of Helicobacter pylori to prevent gastric cancer: a critical appraisal

Jeng-Yih Wu et al. Expert Rev Gastroenterol Hepatol. 2019 Jan.

Abstract

Gastric cancer is one of the top causes of cancer-related death worldwide. How to eliminate gastric cancer is an urgent public-health issue. Areas covered: In this review, we present up-to-date results of studies on gastric cancer prevention through the eradication of Helicobacter pylori and discuss strategies and obstacles for the implementation of population-wide screening and treatment of this pathogen to prevent gastric cancer. Expert commentary: Gastric cancer is an inflammation-associated cancer with multistep carcinogenesis. The process consists of H. pylori infection, ongoing inflammation, development of metaplastic epithelia and genetic instability eventuating in gastric cancer. H. pylori infection is critical for development of the disease and studies have consistently shown that H. pylori eradication results in a reduction in (a) gastric mucosal inflammation, (b) progression of histologic damage, (c) risk of peptic ulcers and ulcer recurrence, and (d) risk of gastric cancer. Compared with a large number of clinical trials evaluating chemopreventive approaches, studies of population-wide screening, and eradication of H. pylori have only recently begun and only in high-risk populations. To eliminate gastric cancer requires information on how to implement an effective program for screening and treatment of H. pylori taking into consideration the other health priorities in any specific population.

Keywords: atrophic gastritis; cancer prevention; gastric cancer; screening.

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Conflict of interest statement

Conflict of interests:

JY Wu and YC Lee do not have conflict of interests. Dr. Graham is a consultant for RedHill Biopharma regarding novel H. pylori therapies and has received research support for culture of Helicobacter pylori and is the PI of an international study of the use of antimycobacterial therapy for Crohn’s disease. He is also a consultant for BioGaia in relation to probiotic therapy for H. pylori infection and for Takeda in relation to H. pylori therapies.

Figures

Figure 1.
Figure 1.
Relative cost-effectiveness of a preventive strategy, compared with no intervention at the grid origin
Figure 2.
Figure 2.
Population screening and treatment for H. pylori infection. (A) The results following the initial screening test in a high H. pylori prevalence population, and (B) the results in a low H. pylori prevalence population such as following one round of mass eradication therapy.
Figure 2.
Figure 2.
Population screening and treatment for H. pylori infection. (A) The results following the initial screening test in a high H. pylori prevalence population, and (B) the results in a low H. pylori prevalence population such as following one round of mass eradication therapy.
Figure 3.
Figure 3.
The age specific risk of cancer in a population with a high risk of gastric cancer such as Japan shown as risk/year/100,000 population. This is superimposed on the population divided into different age categories based on the progression of their H. pylori infection in which the risk of cancer increases as the proportion with atrophic gastritis increases with age.
See this image and copyright information in PMC

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