After Removing Stomach Cancer, Removing H. Pylori Reduces Risk Of Redevelopment

Main Category:GastroIntestinal  Date:2008-8-18 17:52:00  view:33
By removing Helicobacter pylori bacteria fromgastric cancer patients after surgery can reduce the odds of cancerredevelopment dramatically, according to an article released on August1, 2008 in The Lancet.

H. plyori is a virus that usually infects thestomach or small intestines. Once the initial has been removed, anothercancer may appear in a different part of the stomach, in what is calleda metachronous cancer. Infection of the mucosal lining of the stomachhas been associated with almost all stomach cancers, and the WHO hasclassified the bacteria as a group I carcinogen for this stypie ofcancer. In animal models, H. plyori removal prevents stomach cancer,but results of human trials have been mixed.

To help elucidate the effects of H. pylori removal on the prophylaxisof metachronous stomach cancer, Dr Mototsugu Kato and Dr MasahiroAsaka, Hokkaido University Graduate School of Medicine, Japan GastStudy Group performed a randomized controlled trial of 544 patients.Each patient was either newly diagnosed with stomach cancer andplanning to have endoscopic treatment or was in pos-resection follow-upafter this treatment. Subjects were randomly assigned to one of twogroups: a test population administered 30 mg lansoprazole twice perday, 750 mg amoxicillin twice per day, and 200 mg clarithromycin twicedaily for a week; and a control population administered or standardcare but no additional treatment to eradicate H. pylori.

During a three year follow-up, metachronous gastric cancer developed in9 patients in the eradication group (3.3%) and 24 in the control group(8.8%). Overall, the risk of this type of cancer was reduced to onethird of the control risk using this treatment. However, it is notablethat in the group receiving eradication treatment, 19 patents haddiarrhea (7%) and 32 had soft stools (12%).

The authors conclude optimistically: The results of our study suggestthat treatment to eradicate H pylori reduces the risk of developing newgastric carcinoma in patients who have a history of such disease andare thus at risk for developing further gastric cancers...we believethat our data add to those from previous studies showing a causalrelationship between H pylori infection and gastric cancer, and alsosupport the use of H pylori eradication to prevent the development ofgastric cancer.

Dr Nicholas Talley, Mayo Clinic Jacksonville, Florida, USA contributedan accompanying comment which emphasizes the importance of theinvestigation of stomach cancer: Colonoscopy is used to screen forcolorectal cancer in many countries, although direct evidence frompublished randomised trials of benefits versus risks are not available.Yet, worldwide, gastric cancer kills more people, and there is betterevidence that H pylori eradication can prevent mortality than there isfor colonoscopy screening. Preventing gastric cancer by eradicating Hpylori in high-risk regions should be a priority.

Effect of eradication of Helicobacter pylori on incidence ofmetachronous gastric carcinoma after endoscopic resection of earlygastric cancer: an open-label, randomised controlled trial
Kazutoshi Fukase, Mototsugu Kato, Shogo Kikuchi, Kazuhiko Inoue, NaomiUemura, Shiro Okamoto, Shuichi Terao, Kenji Amagai, Shunji Hayashi,Masahiro Asaka, for the Japan Gast Study Group*
Lancet 2008; 372: 392-97
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Written by Anna Sophia McKenney


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