Brief Articles
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Sep 14, 2009; 15(34): 4290-4297
Published online Sep 14, 2009. doi: 10.3748/wjg.15.4290
Does Helicobacter pylori eradication therapy for peptic ulcer prevent gastric cancer?
Katsuhiro Mabe, Mikako Takahashi, Haruhumi Oizumi, Hideaki Tsukuma, Akiko Shibata, Kazutoshi Fukase, Toru Matsuda, Hiroaki Takeda, Sumio Kawata
Katsuhiro Mabe, Division of Gastroenterology, KKR Sapporo Medical Center, Sapporo City 062-0931, Hokkaido, Japan
Mikako Takahashi, Internal Medicine, Tsuruoka Kyoritsu Hospital, Tsuruoka City 997-0816, Yamagata, Japan
Haruhumi Oizumi, Internal Medicine, Oizumi Medical Clinic, Yamagata City 990-0832, Yamagata, Japan
Hideaki Tsukuma, Department of Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City 537-8511, Osaka, Japan
Akiko Shibata, Yamagata Prefectural Medical Center for Cancer and Lifestyle-Related Disease, Yamagata City 990-2292, Yamagata, Japan
Kazutoshi Fukase, Internal Medicine, Yamagata Prefectural Central Hospital, Yamagata City 990-2292, Yamagata, Japan
Toru Matsuda, Yamagata Prefectural Shonai Public Health Center, Mikawa Town 997-1392, Yamagata, Japan
Hiroaki Takeda, Sumio Kawata, Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata City 990-9585, Yamagata, Japan
Author contributions: Mabe K, Oizumi H, Matsuda T, and Tsukuma H designed the research; Mabe K, Takahashi M, Oizumi H, Fukase K, Matsuda T, and Takeda H performed the research; Shibata A and Tsukuma H analyzed the data; Mabe K wrote the paper; Kawata S reviewed the paper.
Correspondence to: Dr. Katsuhiro Mabe, MD, Division of Gastroenterology, KKR Sapporo Medical Center, Sapporo City 062-0931, Hokkaido, Japan. kmabe@kkr-smc.com
Telephone: +81-11-8221811 Fax: +81-11-8329859
Received: June 29, 2009
Revised: July 29, 2009
Accepted: August 5, 2009
Published online: September 14, 2009
Abstract

AIM: To investigate the effects of Helicobacter pylori (H pylori) eradication therapy for treatment of peptic ulcer on the incidence of gastric cancer.

METHODS: A multicenter prospective cohort study was conducted between November 2000 and December 2007 in Yamagata Prefecture, Japan. The study included patients with H pylori-positive peptic ulcer who decided themselves whether to receive H pylori eradication (eradication group) or conventional antacid therapy (non-eradication group). Incidence of gastric cancer in the two groups was determined based on the results of annual endoscopy and questionnaire surveys, as well as Yamagata Prefectural Cancer Registry data, and was compared between the two groups and by results of H pylori therapy.

RESULTS: A total of 4133 patients aged between 13 and 91 years (mean 52.9 years) were registered, and 56 cases of gastric cancer were identified over a mean follow-up of 5.6 years. The sex- and age-adjusted incidence ratio of gastric cancer in the eradication group, as compared with the non-eradication group, was 0.58 (95% CI: 0.28-1.19) and ratios by follow-up period (< 1 year, 1-3 years, > 3 years) were 1.16 (0.27-5.00), 0.50 (0.17-1.49), and 0.34 (0.09-1.28), respectively. Longer follow-up tended to be associated with better prevention of gastric cancer, although not to a significant extent. No significant difference in incidence of gastric cancer was observed between patients with successful eradication therapy (32/2451 patients, 1.31%) and those with treatment failure (11/639 patients, 1.72%). Among patients with duodenal ulcer, which is known to be more prevalent in younger individuals, the incidence of gastric cancer was significantly less in those with successful eradication therapy (2/845 patients, 0.24%) than in those with treatment failure (3/216 patients, 1.39%).

CONCLUSION: H pylori eradication therapy for peptic ulcer patients with a mean age of 52.9 years at registration did not significantly decrease the incidence of gastric cancer.

Keywords: Helicobacter pylori, Peptic ulcer, Gastric cancer, Eradication therapy, Cancer prevention