H. pylori eradication cuts new gastric cancers by half

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.