Vincent Wai-Sun Wong, MD; Francis Ka-Leung Chan, MD
In patients who had endoscopic resection for early gastric cancer, does eradication of Helicobacter pylori reduce risk for metachronous gastric cancer?
Randomized controlled trial.
Unclear allocation concealment.*
51 hospitals in Japan.
544 patients 20 to 79 years of age who had early gastric cancer. At enrollment, patients were newly diagnosed and had planned endoscopic resection or were being followed after endoscopic resection. All patients had active, biopsy-confirmed H. pylori infection. Patients were excluded if they developed a new case of gastric cancer after endoscopic resection (after enrollment but before randomization) or had a history of gastric surgery.
Lansoprazole, 30 mg, amoxicillin, 750 mg, and clarithromycin, 200 mg, all taken twice daily for 1 week (eradication group, n = 272), or standard care with no antibiotics given for H. pylori (n = 272).
New gastric tumors.
93% (mean age 68 y, 76% men) (100% in intention-to-treat analysis).
H. pylori was eradicated in 75% of patients in the eradication group and resolved in 5% of the standard-care group. Fewer patients in the eradication group developed metachronous gastric tumors (Table). There was no interaction (P = 0.48) between treatment and enrollment before (relative risk reduction [RRR] 54%, 95% CI −33 to 84) or after (RRR 73%, CI 21 to 91) endoscopic resection.
In patients having endoscopic resection for early gastric cancer, prophylactic eradication of Helicobacter pylori reduced risk for metachronous gastric cancer.
Helicobacter pylori eradication vs standard care in patients who had endoscopic resection for early gastric cancer†
†Abbreviations defined in Glossary. RRR, NNT, and CI calculated from data in article.
Wong VW, Chan FK. Eradication of H. pylori after endoscopic resection for early gastric cancer reduced risk for metachronous gastric cancer. Ann Intern Med. ;149:JC5–12. doi: 10.7326/0003-4819-149-10-200811180-02012
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Published: Ann Intern Med. 2008;149(10):JC5-12.
Gastric Cancer, Gastroenterology/Hepatology, Gastrointestinal Cancer, H. Pylori, Hematology/Oncology.
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