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. 2025 Jul 1;25(1):463.
doi: 10.1186/s12876-025-04034-3.

Gastric cancer risk after Helicobacter pylori eradication in gastritis and peptic ulcer: a retrospective cohort study in Japan

Kentaro Sugano  1 , Chihiro Suzuki  2 , Mihoko Ota  3   4 , Ryuichi Iwakiri  5
Affiliations

Gastric cancer risk after Helicobacter pylori eradication in gastritis and peptic ulcer: a retrospective cohort study in Japan

Kentaro Sugano et al. BMC Gastroenterol. .

Abstract

Background: Helicobacter pylori infection is an important risk factor for gastric cancer. In Japan, national health insurance has covered eradication therapy for H. pylori infection-associated gastritis from 2013. However, gastric cancer was the fourth leading cause of cancer death in 2023. We aimed to investigate differences in gastric cancer risk among patients with gastritis, gastric ulcer, duodenal ulcer, and gastric ulcer and duodenal ulcer after H. pylori eradication.

Methods: This retrospective cohort study used the JMDC Claims Database from February 21, 2013, to August 31, 2023. Patients who received first-line H. pylori eradication therapy and were diagnosed with H. pylori-associated gastritis, gastric ulcer, or duodenal ulcer in the same month or the month before the first eradication therapy prescription were included. Two antibacterial drugs and an acid secretion inhibitor or triple-drug blister-packaged product were prescribed. The primary outcome was gastric cancer incidence. A Cox proportional hazards regression analysis was used to estimate hazard ratios (HRs). A propensity score approach was used to minimize the effect of confounding measures.

Results: Of 17,245,330 beneficiaries, 148,489 were included. In the weighted cohort (after propensity matching), statistically significant differences were observed in HRs between H. pylori-associated gastritis and duodenal ulcer (HR using the latter as a reference [95% confidence interval]: 2.03 [1.31-3.13]; p = 0.001), and between gastric ulcer and duodenal ulcer (2.37 [1.52-3.71]; p < 0.001). The cumulative probabilities (95% confidence interval) per the median follow-up years (3.8 years for all) were 0.44% (0.39-0.48) for H. pylori-associated gastritis, 0.54% (0.46-0.63) for gastric ulcer, 0.22% (0.10-0.33) for duodenal ulcer, and 0.26% (0.08-0.50) for gastric ulcer and duodenal ulcer.

Conclusions: Patients with H. pylori-associated gastritis and gastric ulcer had a higher risk of gastric cancer than patients with duodenal ulcer, indicating that gastric atrophy remains a risk factor after H. pylori eradication therapy. Careful monitoring, such as by endoscopic examination, is required after successful eradication of H. pylori in patients at higher risk.

Keywords: Claims database; Duodenal ulcer; Eradication therapy; Gastric atrophy; Gastric cancer; Gastric ulcer; Gastritis; Helicobacter pylori.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This was a retrospective study using data from a claims database. Because of the anonymous nature of the analysis and the absence of direct patient involvement, ethical approval and informed patient consent were not required, based on the Ethical Guidelines for Epidemiological Research issued by the Japanese Ministry of Health, Labour and Welfare. Consent for publication: Not applicable. Competing interests: KS has received lecture fees from Biofermin Pharmaceutical Co. Ltd., Fujifilm Medical Co. Ltd., and Takeda Pharmaceutical Company Limited, and consultant fees for participation on a data safety monitoring board or advisory board from Fujifilm Medical Co. Ltd. CS is an employee of Takeda Pharmaceutical Company Limited. MO and RI were employees of Takeda Pharmaceutical Company Limited at the time the study was conducted. No other disclosures were reported.

Figures

Fig. 1
Fig. 1
Study design
Fig. 2
Fig. 2
Patient flowchart of the crude cohort. DU, duodenal ulcer; GDU, gastric ulcer and duodenal ulcer; GU, gastric ulcer; HPAG, Helicobacter pylori–associated gastritis; ITP, idiopathic thrombocytopenic purpura; MALT, mucosa-associated lymphoid tissue
Fig. 3
Fig. 3
Cumulative probability of development of gastric cancer. (A) Crude cohort. (B) Weighted cohort. CI, confidence interval; DU, duodenal ulcer; GDU, gastric ulcer and duodenal ulcer; GU, gastric ulcer; HPAG, Helicobacter pylori–associated gastritis
See this image and copyright information in PMC

References

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