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The following is a summary of “Eradication Therapy to Prevent Gastric Cancer in H. pylori-positive individuals: Systematic Review and Meta-analysis of Randomized Controlled Trials and Observational Studies.,” published in the January 2025 issue of Gastroenterology by Ford et al.

Screening and treating Helicobacter pylori (H. pylori) in the general population or in patients with early gastric neoplasia could significantly reduce the incidence and mortality associated with gastric cancer. This study updates a meta-analysis of randomized controlled trials to evaluate the effect of H. pylori eradication therapy on these outcomes. A comprehensive literature search was conducted through October 4, 2024, identifying studies that assessed the impact of eradication therapy on adults with gastric cancer incidence in H. pylori-positive without baseline gastric neoplasia or patients with H. pylori-positive with gastric neoplasia undergoing endoscopic mucosal resection (EMR). The control groups in the RCTs received either placebo or no eradication therapy, whereas observational studies compared those receiving no eradication therapy. All included studies had a minimum follow-up of two years. The RR for gastric cancer incidence and mortality were calculated.

A total of eleven RCTs and thirteen observational studies met the inclusion criteria. Among the RCTs, the incidence of gastric cancer was significantly lower in healthy H. pylori-positive individuals receiving eradication therapy (eight RCTs: RR 0.64; 95% CI 0.48-0.84) and in patients with H. pylori-positive with gastric neoplasia undergoing EMR (three RCTs: RR 0.52; 95% CI 0.38-0.71). Similarly, the RR of death from gastric cancer was reduced in healthy H. pylori-positive individuals treated with eradication therapy (five RCTs: RR 0.78; 95% CI 0.62-0.98). Observational studies also supported these findings, showing a lower RR of future gastric cancer in H. pylori-positive subjects without baseline gastric neoplasia (eleven studies: RR 0.56; 95% CI 0.43-0.73) and in patients with H. pylori-positive with gastric neoplasia undergoing EMR (two studies: RR 0.19; 95% CI 0.06-0.61).

This meta-analysis reinforces the conclusion that H. pylori eradication therapy effectively reduces the risk of gastric cancer in infected individuals. The consistency of results across RCTs and observational studies strengthens the evidence supporting the preventative role of eradication therapy in reducing both the incidence and mortality of gastric cancer.

Source: sciencedirect.com/science/article/pii/S0016508525000411