H. pylori treatment slows progression in pre-gastric cancer

Anti-Helicobacter pylori treatment provides long-term protection against histological progression among patients at high risk of developing gastric cancer (GC), a new study has found.

Eight hundred adults (mean age, 51±9 years; 46 percent men) initially participated in the trial, all of whom had precancerous lesions. They were randomly assigned to receive anti-H. pylori treatment or placebo. Gastric biopsies were collected at baseline, and at 3, 6, 12, and 20 years, and were evaluated using the Correa histopathology score.

At 20 years, 356 patients remained on the trial and provided data eligible for analysis. Thirty-one patients were diagnosed at the final follow-up to have non-atrophic gastritis (NAG), 83 with multifocal atrophic gastritis without intestinal metaplasia (MAG), 171 with intestinal metaplasia (IM), 70 with dysplasia, and one with GC. At earlier time points, 11 patients had also been diagnosed with GC.

At baseline, 97 percent of patients were positive for H. pylori, which dropped to 41 percent by the 20-year follow-up. Infection status at the final endoscopy had a significant impact on the Correa score, such that those who were negative had a net regression of –0.12 units relative to baseline (p=0.03), while those who were still positive saw a net progression of 0.28 units (p<0.001).

H. pylori status was also associated with regression or progression along the carcinogenesis cascade. For example, patients who had MAG at baseline who were negative at 6 and 12 years showed a full unit decline in the Correa score at the final follow-up compared to those who had the infection. A similar effect was reported at 16 and 20 years.

In general, IM was not reversible to MAG. However, IM patients at baseline who had no H. pylori infection at 16 and 20 years showed a 0.27-unit drop in Correa score relative to their positive comparators.

“[B]oth anti-H. pylori therapy and clearance of the infection showed a long-term beneficial effect on the progression of precancerous lesions,” the researchers said.