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Seventeen-year effects of eradicating Helicobacter pylori on the prevention of gastric cancer in patients with peptic ulcer; a prospective cohort study

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Abstract

Background

We previously reported that eradication of Helicobacter pylori in our cohort of patients with peptic ulcer disease reduced their risk of developing gastric cancer to approximately one–third after a mean follow-up period of 3.4 years (up to 8.6 years). We have now followed these patients for a longer period.

Methods

A total of 1,222 consecutive patients with peptic ulcer diseases who completed more than 1-year follow-up after receiving H. pylori eradication therapy were followed with annual endoscopic surveillance for a mean of 9.9 years (as long as 17.4 years).

Results

H. pylori infection was judged cured in 1,030 patients (eradication-success group) but persisted in 192 (eradication-failure group) after initial eradication therapy. In the eradication-failure group, 114 patients received re-treatment at a mean of 4.4 years after the start of follow-up, and 105 of these were cured of infection. Gastric cancer developed in 21 of the 1,030 patients in the eradication-success group and in nine of the 192 in the failure group (p = 0.04). The risk of developing gastric cancer in the eradication-success group (0.21 %/year) was significantly lower than that in the failure group (0.45 %, p = 0.049). The longest interval between the initial H. pylori eradication and the occurrence of gastric cancer was 14.5 years in the eradication-success group and 13.7 years in the eradication-failure group.

Conclusions

A prophylactic effect for gastric cancer persists for more than 10 years after H. pylori eradication therapy, but we should be aware that cancer can develop even after that interval.

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References

  1. Graham DY. Helicobacter pylori infection is the primary cause of gastric cancer. J Gastroenterol. 2000;35(Suppl 12):90–7.

    PubMed  Google Scholar 

  2. Uemura N, Okamoto S, Yamamoto S, Matsumura N, Yamaguchi S, Yamakido M, et al. Helicobacter pylori infection and the development of gastric cancer. N Engl J Med. 2001;345:784–9.

    Article  CAS  PubMed  Google Scholar 

  3. Fukase K, Kato M, Kikuchi S, Inoue K, Uemura N, Okamoto S, et al. Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial. Lancet. 2008;372:392–7.

    Article  PubMed  Google Scholar 

  4. Fuccio L, Zagari RM, Eusebi LH, Laterza L, Cennamo V, Ceroni L, et al. Meta-analysis: can Helicobacter pylori eradication treatment reduce the risk for gastric cancer? Ann Intern Med. 2009;151:121–8 Epub 2009/07/22.

    Article  PubMed  Google Scholar 

  5. Erratum. Ann Intern Med. 2009;151:516.

  6. You WC, Brown LM, Zhang L, Li JY, Jin ML, Chang YS, et al. Randomized double-blind factorial trial of three treatments to reduce the prevalence of precancerous gastric lesions. J Natl Cancer Inst. 2006;98:974–83 Epub 2006/07/20.

    Article  PubMed  Google Scholar 

  7. Ma JL, Zhang L, Brown LM, Li JY, Shen L, Pan KF, et al. Fifteen-year effects of Helicobacter pylori, garlic, and vitamin treatments on gastric cancer incidence and mortality. J Natl Cancer Inst. 2012;104:488–92 Epub 2012/01/25.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Take S, Mizuno M, Ishiki K, Nagahara Y, Yoshida T, Inaba T, et al. Interleukin-1beta genetic polymorphism influences the effect of cytochrome P 2C19 genotype on the cure rate of 1-week triple therapy for Helicobacter pylori infection. Am J Gastroenterol. 2003;98:2403–8.

    CAS  PubMed  Google Scholar 

  9. Ishiki K, Mizuno M, Take S, Nagahara Y, Yoshida T, Yamamoto K, et al. Helicobacter pylori eradication improves pre-existing reflux esophagitis in patients with duodenal ulcer disease. Clin Gastroenterol Hepatol. 2004;2:474–9.

    Article  PubMed  Google Scholar 

  10. Take S, Mizuno M, Ishiki K, Nagahara Y, Yoshida T, Yokota K, et al. The effect of eradicating Helicobacter pylori on the development of gastric cancer in patients with peptic ulcer disease. Am J Gastroenterol. 2005;100:1037–42.

    Article  PubMed  Google Scholar 

  11. Take S, Mizuno M, Ishiki K, Nagahara Y, Yoshida T, Yokota K, et al. Baseline gastric mucosal atrophy is a risk factor associated with the development of gastric cancer after Helicobacter pylori eradication therapy in patients with peptic ulcer diseases. J Gastroenterol. 2007;42(Suppl 17):21–7.

    Article  PubMed  Google Scholar 

  12. Take S, Mizuno M, Ishiki K, Nagahara Y, Yoshida T, Yokota K, et al. Helicobacter pylori eradication may induce de novo, but transient and mild, reflux esophagitis: prospective endoscopic evaluation. J Gastroenterol Hepatol. 2009;24:107–13.

    Article  PubMed  Google Scholar 

  13. Take S, Mizuno M, Ishiki K, Yoshida T, Ohara N, Yokota K, et al. The long-term risk of gastric cancer after the successful eradication of Helicobacter pylori. J Gastroenterol. 2011;46:318–24 (Epub 2010/11/26).

    Article  PubMed  Google Scholar 

  14. Take S, Mizuno M, Ishiki K, Imada T, Okuno T, Yoshida T, et al. Reinfection rate of Helicobacter pylori after eradication treatment: a long-term prospective study in Japan. J Gastroenterol. 2012;47:641–6 (Epub 2012/02/22).

    Article  PubMed  Google Scholar 

  15. Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance in chronic gastritis. Endoscopy. 1969;3:87–97.

    Article  Google Scholar 

  16. Sakaki N, Arakawa T, Katou H, Momma K, Egawa N, Kamisawa T, et al. Relationship between progression of gastric mucosal atrophy and Helicobacter pylori infection: retrospective long-term endoscopic follow-up study. J Gastroenterol. 1997;32:19–23.

    Article  CAS  PubMed  Google Scholar 

  17. Ito S, Azuma T, Murakita H, Hirai M, Miyaji H, Ito Y, et al. Profile of Helicobacter pylori cytotoxin derived from two areas of Japan with different prevalence of atrophic gastritis. Gut. 1996;39:800–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Satoh K, Kimura K, Taniguchi Y, Yoshida Y, Kihira K, Takimoto T, et al. Distribution of inflammation and atrophy in the stomach of Helicobacter pylori-positive and -negative patients with chronic gastritis. Am J Gastroenterol. 1996;91:963–9.

    CAS  PubMed  Google Scholar 

  19. Nagahara Y, Mizuno M, Maga T, Ishiki K, Okuno T, Yoshida T, et al. Outcome of patients with inconsistent results from 13C-urea breath test and bacterial culture at the time of assessment of Helicobacter pylori eradication therapy in Japan. Hepatogastroenterology. 2003;50:1700–3.

    PubMed  Google Scholar 

  20. Lauren P. The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. Acta Pathol Microbiol Scand. 1965;64:31–49.

    CAS  PubMed  Google Scholar 

  21. Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney system. International workshop on the histopathology of gastritis, Houston 1994. Am J Surg Pathol. 1996;20:1161–81 Epub 1996/10/01.

    Article  CAS  PubMed  Google Scholar 

  22. Wu CY, Kuo KN, Wu MS, Chen YJ, Wang CB, Lin JT. Early Helicobacter pylori eradication decreases risk of gastric cancer in patients with peptic ulcer disease. Gastroenterology. 2009;137(1641–8):e1–2 Epub 2009/08/12.

    Google Scholar 

  23. Konno M, Yokota S, Suga T, Takahashi M, Sato K, Fujii N. Predominance of mother-to-child transmission of Helicobacter pylori infection detected by random amplified polymorphic DNA fingerprinting analysis in Japanese families. Pediatr Infect Dis J. 2008;27:999–1003 Epub 2008/10/11.

    Article  PubMed  Google Scholar 

  24. Ford AC, Forman D, Hunt RH, Yuan Y, Moayyedi P. Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomised controlled trials. BMJ. 2014;348:g3174.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Graham DY, Shiotani A. The time to eradicate gastric cancer is now. Gut. 2005;54:735–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Asaka M, Kato M, Sakamoto N. Roadmap to eliminate gastric cancer with Helicobacter pylori eradication and consecutive surveillance in Japan. J Gastroenterol. 2014;49:1–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

S. Take and M. Mizuno contributed principally and equally to the study. The authors thank to Drs. Tsuyoshi Okamoto, Tomomi, Hakoda, Takayuki Imada, Masako Kataoka, Yoshimi Itoh and Hideaki Inoue (Nippon Kokan Fukuyama Hospital) for support of this work and Dr. William R. Brown (Denver, Colorado) for assistance in preparation of the manuscript. This work was supported in part by Health Labour Sciences Research Grant, The Ministry of Health Labour and Welfare, Tokyo, Japan.

Conflict of interest

The authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Internal Medicine, Fukuwatari Municipal Hospital, Okayama, Japan

    Susumu Take

  2. Department of Internal Medicine, Hiroshima City Hospital, 7-33 Motomachi, Nakaku, Hiroshima, 730-8518, Japan

    Motowo Mizuno

  3. Department of Internal Medicine, Nippon Kokan Fukuyama Hospital, Fukuyama, Japan

    Susumu Take, Kuniharu Ishiki & Tomowo Yoshida

  4. Department of Surgery, Nippon Kokan Fukuyama Hospital, Fukuyama, Japan

    Fumihiro Hamada

  5. Department of Bacteriology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan

    Kenji Yokota

  6. Department of Medicine and Medical Science, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan

    Hiroyuki Okada & Kazuhide Yamamoto

Authors
  1. Susumu Take
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  2. Motowo Mizuno
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  3. Kuniharu Ishiki
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Correspondence to Motowo Mizuno.

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Take, S., Mizuno, M., Ishiki, K. et al. Seventeen-year effects of eradicating Helicobacter pylori on the prevention of gastric cancer in patients with peptic ulcer; a prospective cohort study. J Gastroenterol 50, 638–644 (2015). https://doi.org/10.1007/s00535-014-1004-5

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  • DOI: https://doi.org/10.1007/s00535-014-1004-5

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