Preventive Effect of Helicobacter pylori Treatment on Gastric Cancer Incidence and Mortality: A Korean Population Study

Abstract

Background & aims: Helicobacter pylori (H pylori) infection is a major risk factor for gastric cancer (GC); however, whether H pylori eradication (HPE) benefits the older population remains unclear. We compared GC incidence and mortality between H pylori-treated individuals and the general population, stratified by age.

Methods: We conducted a population-based study in South Korea involving 916,438 individuals aged ≥20 years who underwent HPE therapy between 2009 and 2011, with follow-up until 2021. Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) for GC were calculated, comparing H pylori-treated individuals with the general population.

Results: The mean follow-up period was 12.4 ± 1.1 years. GC incidence and mortality rates were significantly lower in H pylori-treated individuals than in the general population across all age-groups (30-39, 40-49, 50-59, 60-69, and ≥70 years), except for the 20 to 29 years age-group. Notably, in the 70 to 74, 75 to 79, and ≥80 years age-groups, GC incidence and mortality in H pylori-treated individuals remained significantly lower. The SIRs for these groups were 0.56 (95% confidence interval [CI], 0.52-0.61), 0.48 (95% CI, 0.42-0.54), and 0.36 (95% CI, 0.28-0.46), respectively, and the SMRs were 0.30 (95% CI, 0.25-0.35), 0.38 (95% CI, 0.31-0.47), and 0.43 (95% CI, 0.30-0.59), respectively.

Conclusions: HPE may help prevent GC and improve survival in adults of all ages, including those aged ≥70 years. These findings suggest that HPE benefits not only younger adults but also older adults. HPE treatment is preferable at a younger age, but older age may not be a limiting factor for the treatment.

Keywords: Age; Eradication; Helicobacter pylori; Prevention; Stomach Cancer.