Gastric cancer: for first-degree relatives, risk halved after H pylori treatment

  • Choi IJ & al.
  • N Engl J Med
  • 30 Jan 2020

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Eradication treatment for Helicobacter pylori infection cuts gastric cancer risk by 55% among first-degree relatives of patients with gastric cancer.
  • Authors emphasize importance of confirming eradication.

Why this matters

  • Having a first-degree relative with gastric cancer can multiply personal risk. 
  • Because of lack of evidence, 2017 American College of Gastroenterology guidelines did not include a recommendation about routine H pylori testing and treatment for this group, though other guidelines recommend doing so.

Key results

  • Median follow-up: 9.2 years.
  • Eradication vs placebo group: 
    • Gastric cancer onset: 1.2% (10/832) vs 2.7% (23/844; P=.03).
    • Of 10 in the eradication group who developed cancer, 5 had persistent infection.
    • HR, 0.45 (95% CI, 0.21-0.94).
    • Adverse events: 53.0% vs 19.1% (P<.001 no deaths>
  • Gastric cancer onset in participants from either group with eradicated vs persistent infection: 0.8% (5/608) vs 2.9% (28/979).
    • HR, 0.27 (95% CI, 0.10-0.70).

Study design

  • Single-center, double-blind, placebo-controlled trial of people ages 40-65 years who were positive for H pylori infection and whose first-degree relative had cancer (n=1838).
  • Researchers randomly assigned participants to eradication therapy vs placebo.
  • All underwent endoscopic surveillance every 2 years.
  • Outcome: gastric cancer.
  • Funding: National Cancer Center, South Korea.

Limitations

  • No analysis of patient genetics, bacterial risk factors.