Does treatment for H. pylori in close relatives of persons with gastric cancer reduce the likelihood that the relatives will develop gastric cancer?

For first-degree relatives of patients with gastric cancer who test positive for Helicobacter pylori, eradicating that infection significantly reduces their risk for developing gastric cancer. The surveillance used in this South Korean study is of course not standard care, and it is possible that outcomes may be different if patients waited until cancers were symptomatic, especially if overdiagnosis of indolent cancers occurs. It is also possible the benefit is lower in countries where the prevalence of H. pylori infection is lower than in South Korea. (LOE = 1b)

Choi IJ, Kim CG, Lee JY, et al. Family history of gastric cancer and Helicobacter pylori treatment. N Engl J Med 2020;382(5):427-436.  [PMID:31995688]

Randomized controlled trial (double-blinded)

Government

Concealed

Population-based

There is a strong association between H. pylori infection and gastric cancer. These Korean researchers identified 1838 participants with a first-degree relative with gastric cancer. The participants were randomized to receive H. pylori treatment or placebo. The treatment consisted of amoxicillin 1000 mg, clarithromycin 500 mg, and lansoprazole 30 mg twice daily for 7 days. The participants had a mean age of 49 years (range = 40 to 65 years), 49% were men, and 43% were current or former smokers. The authors report the results for the modified intention-to-treat analysis of the 1676 patients with follow-up data. All patients underwent esophagoduodenoscopy every 2 years, with a median follow-up of 9.2 years for cancer incidence and 10.2 years for overall survival. Patients in the treated group had a lower incidence of gastric cancer (1.2% vs 2.7%; P = .03). The likelihood of gastric cancer was also lower for participants in whom H. pylori was eradicated than in those with persistent infection (0.8% vs 2.9%). There was no difference in all-cause mortality (1.7% in the treatment group vs 2.0% in the placebo group).