Helicobacter Pylori Eradication as a Preventive Tool Against Gastric Cancer


Helicobacter pylori (H. pylori), which increases the risk of gastric diseases, including digestive ulcers and gastriccancer, is highly prevalent in Asian countries. There is no doubt that eradication of the bacterium is effective as atreatment of digestive ulcer, but eradication aiming to reduce the gastric cancer risk is still controversial. Observationalstudies in Japan demonstrated that the eradication decreased the gastric cancer risk among 132 stomach cancerpatients undergoing endoscopical resection (65 treated with omeprazol and antibiotics and 67 untreated). In Columbia,976 participants were randomized into eight groups in a three-treatment factorial design including H. pylorieradication, resulting in significant regression in the H. pylori eradication group. A recent randomized study inChina also showed a significant reduction of gastric cancer risk among those without any gastric atrophy, intestinalmetaplasia, and dysplasia. Efficacy of eradication may vary in extent among countries with different incidence ratesof gastric cancer. Since the lifetime cumulative risk (0 to 84 years old) of gastric cancer in Japan is reported to be12.7% for males and 4.8% for females (Inoue and Tominaga, 2003), the corresponding values for H. pylori infectedJapanese can be estimated at 21.2% in males and 8.0% in females under the assumptions that the relative risk forinfected relative to uninfected is 5 and the proportion of those infected is 0.5. Both the fact that not all individuals areinfected among those exposed and the knowledge that only a small percentage of individuals infected with thebacterium develop gastric cancer, indicate the importance of gene-environment interactions. Studies on suchinteractions should provide useful information for anti-H. pylori preventive strategies.