From the Journals

H. pylori eradication cuts new gastric cancers by half

 

Key clinical point: Among patients undergoing endoscopic resection of early gastric cancer, incidence of new gastric cancers was approximately 50% lower for those who received treatment for Helicobacter pylori infection.

Major finding: Over a median follow-up of 5.9 years, new gastric cancers developed in 14 patients (7.2%) who received treatment, and in 27 patients (13.4%) who received placebo (HR, 0.50; 95% CI, 0.26-0.94; P = .03).

Study details: A prospective, double-blind, placebo-controlled, randomized trial of 470 patients who underwent endoscopic resection for high-grade adenoma or early gastric cancer.

Disclosures: The authors reported that they had nothing to disclose related to the study.

Source: Choi et al. N Engl J Med. 2018 Mar 22. doi: 10.1056/NEJMoa1708423.

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Striking result in early gastric cancer patients

The study by Choi and colleagues suggests Helicobacter pylori eradication is effective at stopping the carcinogenic process in patients with severe chronic atrophic gastritis, an advanced precursor lesion to gastric cancer, according to Peter Malfertheiner, MD.

“It is a striking finding that H. pylori eradication may still be effective at this stage, since such therapy decreased the development of gastric cancer by 50% in this trial,” Dr. Malfertheiner wrote in an editorial.

In the randomized, placebo-controlled trial, H. pylori eradication after endoscopic removal of early stage disease effectively prevented metachronous gastric cancers (i.e., those detected on endoscopy at 1-year follow-up or thereafter) with a hazard ratio of 0.50, Dr. Malfertheiner noted.

The results confirm and strengthen previous findings by showing a significant improvement in atrophic gastritis, he added.

“In this endoscopic procedure, removal of early gastric cancer or high-grade adenoma leaves the stomach largely conserved but with the atrophic gastric mucosa remaining in a preneoplastic ‘alarm state,’ ” he noted.

However, the potential link between cancer recurrence and atrophic gastritis was not explored in this particular study report, Dr. Malfertheiner said. Thus, it is unclear whether gastric cancer recurrence was prevented specifically in the subset of patients with atrophic gastritis.

It could be that eradication of H. pylori directly arrests carcinogenic mechanisms directly by ending persistent inflammation, he speculated.

“The beneficial effect may also be mediated by an alteration in the composition of the gastric microbiota because of improvement in the grade of gastric atrophy and a return toward normal gastric acid production,” he added.

Dr. Malfertheiner is with the Clinic of Gastroenterology, Otto von Guericke University, Magdeburg, Germany. These comments are derived from his editorial (N Engl J Med. 2018 Mar 22. doi: 10.1056/NEJMe1800147). Dr. Malfertheiner reported personal fees from Allergan, Biohit, and Infai outside the submitted editorial.


 

FROM THE NEW ENGLAND JOURNAL OF MEDICINE

Treatment for Helicobacter pylori infection cut the incidence of new gastric cancers in half among patients undergoing endoscopic resection of early gastric cancer, according to results of a recent randomized, placebo-controlled study.

Patients receiving H. pylori treatment also had greater improvement from baseline in grade of gastric corpus atrophy, compared with patients receiving placebo, according to the study. The results were published in the New England Journal of Medicine.

Helicobacter pylori ©sgame/thinkstockphotos.com

“We speculate that persistent inflammation of gastric mucosa with H. pylori infection promotes carcinogenesis and also increases tumor growth or invasiveness,” said Il Ju Choi, MD, PhD, of the Center for Gastric Cancer, National Cancer Center, Goyang, South Korea, and coauthors.

Patients with early gastric cancers not at risk for lymph node metastasis may benefit from endoscopic resection. However, these patients are at high risk of developing new gastric cancer, and usually experience glandular atrophy, or advanced loss of mucosal glandular tissue, the authors said.

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