Esophagus to Small Intestine
Gastroenterology. 2023;165(2):391–401.e2
Effect of Helicobacter pylori eradication therapy on the incidence of non-cardia gastric adenocarcinoma in a large diverse population in the United States
Background and aims: High-quality data regarding the effect of Helicobacter pylori eradication on the risk of non-cardia gastric adenocarcinoma (NCGA) remain limited in the United States. The authors investigated the incidence of NCGA after H. pylori eradication therapy in a large, community-based US population.
Methods: They performed a retrospective cohort study of Kaiser Permanente Northern California members who underwent testing and/or treatment for H. pylori between 1997 and 2015 and were followed through December 31, 2018. The risk of NCGA was evaluated using the Fine-Gray subdistribution hazard model and standardized incidence ratios.
Results: Among 716,567 individuals with a history of H. pylori testing and/or treatment, the adjusted subdistribution hazard ratios and 95% confidence intervals of NCGA for H. pylori-positive/untreated and H. pylori-positive/treated individuals were 6.07 (4.20–8.76) and 2.68 (1.86–3.86), respectively, compared with H. pylori-negative individuals. When compared directly with H. pylori-positive/untreated individuals, subdistribution hazard ratios for NCGA in H. pylori-positive/treated were 0.95 (0.47–1.92) at < 8 years and 0.37 (0.14–0.97) ≥ 8 years of follow-up. Compared with the Kaiser Permanente Northern California general population, standardized incidence ratios (95% confidence interval) of NCGA steadily decreased after H. pylori treatment: 2.00 (1.79–2.24) ≥ 1 year, 1.01 (0.85–1.19) ≥ 4 years, 0.68 (0.54–0.85) ≥ 7 years, and 0.51 (0.38–0.68) ≥ 10 years.
Conclusion: In a large, diverse, community-based population, Helicobacter pylori eradication therapy was associated with a significantly reduced incidence of non-cardia gastric adenocarcinoma after 8 years compared with no treatment. The risk among treated individuals became lower than the general population after 7 to 10 years of follow-up. The findings support the potential for substantial gastric cancer prevention in the United States through H. pylori eradication.