Eradication Therapy to Prevent Gastric Cancer in H. pylori-positive individuals: Systematic Review and Meta-analysis of Randomized Controlled Trials and Observational Studies.

Background & aims

Screening for, and treating, Helicobacter pylori (H. pylori) in the general population or patients with early gastric neoplasia could reduce incidence of, and mortality from, gastric cancer. We updated a meta-analysis of randomized controlled trials (RCTs) examining this issue.

Methods

We searched the literature through 4th October 2024, identifying studies examining effect of eradication therapy on incidence of gastric cancer in H. pylori-positive adults without gastric neoplasia at baseline or H. pylori-positive patients with gastric neoplasia undergoing endoscopic mucosal resection (EMR) in either RCTs or observational studies. The control arm received placebo or no eradication therapy in RCTs and no eradication therapy in observational studies. Follow-up was ≥2 years. We estimated relative risks (RR) of gastric cancer incidence and mortality.

Results

Eleven RCTs and 13 observational studies were eligible. For RCTs, RR of gastric cancer was lower with eradication therapy in healthy H. pylori-positive individuals (eight RCTs: 0.64; 95% CI 0.48-0.84) and H. pylori-positive patients with gastric neoplasia undergoing EMR (three RCTs: 0.52; 95% CI 0.38-0.71). RR of death from gastric cancer was lower with eradication therapy in healthy H. pylori-positive individuals (five RCTs: 0.78; 95% CI 0.62-0.98). In observational studies, RR of future gastric cancer was lower with eradication therapy in H. pylori-positive subjects without gastric neoplasia at baseline (11 studies: 0.56; 95% CI 0.43-0.73) and H. pylori-positive patients with gastric neoplasia undergoing EMR (two studies: 0.19; 95% CI 0.06-0.61).

Conclusions

This meta-analysis provides further evidence that administering eradication therapy prevents gastric cancer in H. pylori-positive individuals, with consistency in results among studies of different design.